Antiseptic and Aseptic Techniques Are Developed

Overview

The development of antiseptic and aseptic techniques had a dramatic impact on the health and life of those living in the late-nineteenth century. Essentially, these techniques combat the growth and transmission of harmful organisms. Antisepsis, meaning the topical destruction of bacteria, was developed as an offshoot of French bacteriologist Louis Pasteur's germ theory. Asepsis, meaning the absence of harmful organisms, was a later refinement of antisepsis and led to the development of modern surgery. Both techniques vastly reduced infection rates and, therefore, increased survivability from trauma or disease. Antisepsis and asepsis influenced industry and accompanied cultural changes during the latter Victorian period and into the Industrial Revolution.

Background

English surgeon Joseph Lister (1827-1912) pioneered modern antisepsis. Based on Pasteur's earlier studies of fermentation and putrefaction, Lister reasoned that tissue breakdown from infection was caused by minute organisms. Lister developed an antibacterial solution containing carbolic acid, first spraying it in the air and then on his surgical instruments. When Lister first applied his antibacterial solution directly to compound fracture wounds in 1865, he observed that its use resulted in dramatically lower rates of infection. Lister subsequently championed cleanliness in the surgical operative area and embraced the burgeoning antiseptic techniques contributed by his contemporaries. Lister's reputation allowed him to serve as surgeon to Queen Victoria, who granted him the title of Baron in 1897.

Though successful, early antiseptic techniques were not immediately adopted by practicing physicians. Pasteur's germ theory initially created confusion among the medical community, some of whom doubted its clinical significance. As early as 1846 Austrian physician Ignaz Semmelweis (1818-1865) suggested that physician handwashing between attending patients lowered infection rates. While working in obstetrics at the Vienna General Hospital, Semmelweis observed high mortality rates among mothers with post-partum fever, or puerperal sepsis, in one of the units where physicians and medical students attended births, performed surgeries, and conducted autopsies. Semmelweis also observed that in another unit where midwives attended births, mortality was significantly lower. When a colleague of Semmelweis died of sepsis after puncturing his finger during an autopsy, Semmelweis connected the two events. Semmelweis concluded that contamination with the infectious material itself might spread a disease from person to person. To break this chain of infection he insisted that physicians wash their hands after autopsies with a lime chloride solution and wash with soap and water between attending births. Although mortality rates from puerperal sepsis plummeted, Semmelweis' techniques were initially discounted. Hospital practice was reluctant to change, and the development of antiseptic technique suffered a setback. Semmelweis died impoverished in a mental institution in 1865.

By 1880, based on the work of Lister, infections and particularly post-surgical infections continued to decline. Within a generation antisepsis was refined to asepsis, meaning the absence of harmful organisms. Asepsis is achieved mainly through sterilization. German physician Ernst von Bergmann (1836-1907) made a major breakthrough in asepsis when he introduced steam sterilization of surgical instruments in 1885. Born in Latvia, Bergmann was professor of surgery at the universities of Berlin and Würzburg. He is also credited with introducing the sterilization of wound dressings and other medical equipment used during surgical operations. Bergmann's method used steam under pressure and is the basis for modern sterilization procedures. American surgeon William Stuart Halstead (1852-1922) introduced sterile rubber gloves to surgery in 1898. Spurred by his fiancé's complaint that continued antiseptic use and handwashing were irritating to the hands, Halstead's innovation further minimized the opportunity for cross contamination between surgeon and patient. Halstead was the first professor of surgery at Johns Hopkins University, where he revolutionized surgical technique, including the meticulous handling of tissues during surgery.

Impact

The nineteenth-century development of antisepsis and aseptic technique laid the foundation for the ascent of modern surgical technique. Prior to Lister's discovery of antisepsis, almost 80% of surgical patients contacted gangrene from operations performed in rooms with poor ventilation and crowded by observers. Surgeons wore street clothes, sometimes with aprons, seldom changing either between patients. At best, instrument preparation consisted only of washing with soap and water. Sawdust from mill floors was used both as wound dressing and as an absorbent material for the surgical floor. Surgery was the last resort in the physician's armamentarium (methods of treatment) and was most often performed in conjunction with a traumatic or wartime injury. Unreliable anesthesia and battlefield conditions created urgency that did little to foster antisepsis. Amputated limbs and tissues were stored haphazardly, often collected in a central area and disposed of only at the end of the day. Autopsies were performed in the same area as surgeries. Amid these conditions disease flourished and Lister and his contemporaries campaigned for change.

With Bergmann's refinement of antisepsis to aseptic techniques, surgery saw an unprecedented boom in innovation, beginning in 1890 and continuing into the early twentieth century. Low mortality rates and advances in anesthesia made surgery an option less dire. As more surgeries were performed, knowledge of anatomy and especially physiology increased. This new knowledge led to the effective performance of surgery for treatment of internal diseases. The body's reaction to injury became better understood, which aided in often-performed trauma surgery. Surgeries that were previously assumed impossible became practical realities. Bergmann, a neurosurgeon, was among these pioneers, introducing stringent standards of surgical asepsis while performing procedures on the brain and spinal cord. Some physicians began to advocate use of presumed preventive surgeries such as circumcision of the newborn and removal of the adenoids during childhood. Hospitals dedicated rooms solely for the purpose of surgery, where aseptic techniques were maintained.

Nursing also contributed to the lower mortality rates of the time. Nurses incorporated post-surgical antiseptic and aseptic techniques while caring for their patients, and they advocated improvements in hospital environmental cleanliness, while delivering and teaching enhanced personal hygiene for those in their care. Hospitals began to be perceived as sanitary institutions in which to benefit from the latest medical care rather than the crowded, dreadful institutions of the past. The number of hospitals greatly increased from 1870 until after the turn of the century to accommodate those patients benefiting from new medical advances made possible by the discovery of aseptic techniques. Medical professions also experienced a boom as universities and hospitals trained physicians and nurses. Medical and surgical research entered into an exuberant phase of innovation.

By 1880 principles of antisepsis and the germ theory influenced social culture in the Western world. Cleanliness was perceived as essential to both personal and social responsibility. As a result of these new sensitivities, nineteenth-century society rediscovered and returned to ancient traditions (often grounded in religious traditions) that called for frequent bathing. Dirt was perceived to be hazardous. The middle class embraced cleanliness as a method of displaying prosperity. The later Victorian period was an age concerned with class stratification, and standards of cleanliness became a measure of not only social standing but moral character as well. Refinement and spirituality were associated with cleanliness, while the unclean were described as base and animalistic.

Some normal human bodily functions became associated with dirt, thereby carrying moral significance as well. Healthy genital organs were considered contaminated due to their function.

Physicians often adopted this prevailing attitude, sometimes labeling normal body secretions as infectious material. This provided the context for the endorsement of universal circumcision as preventive medicine. Maternal mortality in childbirth also continued, with efforts to further reduce it sometimes hampered by moralists. Many physicians and theologians still considered puerperal fever as a manifestation of God's intent to punish woman during childbirth. Although Listerian antisepsis had a dramatic initial effect on lowering maternal mortality, some hospitals still had 7% mortality rates as late as 1895. Women who had their babies at home attended by physicians or midwives greatly outnumbered women who gave birth in hospitals.

The emphasis on antisepsis also influenced industry at the dawn of the industrial age. The pharmaceutical industry developed new medicines and manufactured them under antiseptic conditions. Pasteurization, a process of semi-sterilization that eliminates bacteria responsible for spoilage, saved the wine industry in Europe. The availability and distribution of milk greatly increased, as did its consumption, after the pasteurization process was applied. Improved canning methods led to increased distribution and longer shelf life of foods. With improved food preservation came greater population mobility. Many who previously farmed for their sustenance moved to the cities for opportunities with burgeoning industry. Growing cities assumed the challenge of maintaining a water supply free from harmful organisms and developing an organized waste disposal system. Agencies in urban centers arose to recognize, track, and research trends in infections and matters of public health. Many of these, such as the Pasteur Institute in Paris and the Lister Institute of Preventive Medicine in London, still exist today.

BRENDA WILMOTH LERNER

Further Reading

Haeger, Knut. The Illustrated History of Surgery. New York: Bell Publishing, 1988.

Tomes, Nancy. The Gospel of Germs: Men, Women, and the Microbe in American Life. Cambridge, MA: Harvard University Press, 1998.