|Actor’s turn as Lister delights conference|
|Wednesday, 29 February 2012|
Highlights from the after-dinner speech on Thursday 9 February, delivered by a surprise special guest
I have spent many years living, working, teaching and studying in Edinburgh, but cannot be certain how much longer I’ll remain. Kings College in London have been making overtures for my services, and I fear I may not be able to refuse them much longer.
You see, at long last, my ideas on germ theory and the antiseptic principle are gradually being adopted both here in Scotland and abroad. But in England? No. They still refuse to accept the very real benefits of antiseptic surgery. And surgery has been my passion, ever since, as a student in London, I witnessed the great Robert Liston perform the first ever operation conducted under ether.
Robert Liston… there was a man. Before anaesthesia, when speed was essential to reduce pain and improve the chances of survival, it’s said that he could amputate a limb in less than a minute! And in those days, he must have been a sight to behold; one account describes him springing across the blood-stained floorboards upon his swooning, sweating, strapped-down patient calling, “Time me, gentlemen! Time me!” to his students in the galleries. The first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous, and to free both hands, he would clasp the bloody knife between his teeth.
“If germs entering from outside the wound caused infection, then there had to be a way of killing those germs before they entered the body”
And back then, just as when I began practicing, a surgeon was not required to wash his hands before tending to a patient, and I put my own hands up… my dirty hands, as it were… for I was as guilty as anyone else. I wore an old frock-coat for operations, which was stiff and glazed with blood. In fact, a blood spattered surgeon’s coat was considered to be a mark of his knowledge and experience. What I know now makes me recoil in horror.
What these stories illustrate is the lack of surgical hygiene at that time. And it is this link to post-operative infection that has become my life’s work ever since I arrived in Edinburgh some 24 years ago, under the watchful eye of our finest ever surgeon – Mr James Syme. I owe everything to that man. He took me under his wing and gave me every opportunity I could need to progress in the medical world. And just as importantly, he was father to my beautiful wife, Agnes, who remains a constant source of strength and inspiration to me.
It was around this time that surgical operations were becoming more common, due to the use of chloroform as an anaesthetic, thanks to a certain James Young Simpson. Now, surgical operations, even under chloroform, were considered a last resort due to the high mortality rate caused by infection in the recovery period. Simpson himself said, “A man laid on the operating table in one of our surgical hospitals is exposed to more chance of death than was the English soldier on the field at Waterloo.”
In fact, over 30 years ago, doctors like Holmes and Semmelweiss were already arguing the case for improved hygiene to reduce infections. Semmelweiss had his doctors wash their hands in calcium chloride before and after operations, and deaths on his wards fell from 12% to just 1%. But because they could not actually prove there was a link between hygiene and infection, their views were dismissed as the ramblings of eccentrics. Some said, "There is no object in a surgeon being clean.” Others said, “An executioner might as well manicure his nails before chopping off a head". These doubters believed that the infection arose spontaneously inside the wound, and was due to the patient being exposed to “bad air”, or “miasma”, and that nothing could be done about it.
It was while I was Professor of Surgery at Glasgow University that I started to see where the link between hygiene and infection could be made. The great French chemist, Louis Pasteur, produced a paper addressing the problem of wine going bad due to faulty fermentation. He argued that organisms didn’t come to life spontaneously within the wine... in the manner our surgeons suggested happened with open wounds. He proved it was caused by germs entering the fermentation process from the air. This made immediate sense to me, and after conducting my own experiments with urine, I came to similar conclusions as Pasteur. And if germs entering from outside the wound caused infection, then there had to be a way of killing those germs before they entered the body.
My task was to discover a chemical which would do this job, and I began to experiment with carbolic acid, which I had witnessed being used to great effect in treating the sewers of Carlisle. I used this solution to wash my hands; to spray instruments, surgical incisions and dressings; and to thoroughly clean a wound – almost immediately, infections reduced, and survival rates increased remarkably.
My first real success was with an 11-year-old boy by the name of James Greenlees. Poor James had been run over by a cart, leaving him with a terrible compound fracture to his leg. I washed the wound thoroughly with the carbolic acid solution. I then dressed the wound with a kind of carbolic putty and covered it with tin foil. After four days, when I went to renew the pad, I discovered that no infection had developed. The process was repeated every few days and after just six weeks, young James walked out of that ward on two healthy legs.
I then developed a machine that I’m sure you’re all familiar with. Along the lines of a perfume spray, it pumped out a fine mist of carbolic acid into the air around an operation. Unfortunately, this wasn’t as pleasant on the senses as perfume, and wasn’t very popular with the surgeons, but it was a small price to pay for its success.
Since then, I’ve had the honour to return to Edinburgh to take over Mr Syme’s post at the university, where my research has continued. In particular, I have greatly improved the quality of our dressings, and have replaced my carbolic solution with one of boracic acid, reducing inflammation. I continue to experiment in improving the quality of ligatures, which themselves can lead to infection. Silk has long been perceived as the best material, but my experiments with the less pliable, but more absorbent catgut soaked in my antiseptic solution are proving encouraging.
But, as is often the case with new ideas, professional acceptance has been painfully slow. Many of my colleagues have a problem with the whole concept of ‘germ theory’. James Young Simpson… oh, we are indebted to him for his early experimentations with chloroform, but as for his constant sniping opposition to my work … well, perhaps history will be the judge. And Dr James Spence, and in particular, our own Dr Bennet, Professor of Physiology, have thrown my ideas back in my face… “Where are the germs? Show them to us and we will believe. Has anybody seen these germs?” they would say. And James Morton in Glasgow still cannot accept that something so small that can barely be detected under a microscope can have the power to kill a man. He has the audacity to dismiss my work as, “Merely a hobby that has been taken too far!”
It has been a long road and there is much work still to be done. But slowly, my theories have begun to gain acceptance, and if I do indeed make the move to Kings College, I am sure I can continue to convince my profession of the very real benefits of hygienic surgery. For my endeavours are more important to me than personal prestige. For me, it has always been, and always will be, about saving lives.