and he respondedwithpolemic.His failure to convincehis fellowdoctorswas
not helpedby his poor ability to communicate. In 1865,he suffereda nervous
breakdown and was committedto an insane asylumwherehe soondiedfrom
bloodpoisoning. OnlyafterDr Semmelweis'sdeathwas the germtheory of
diseasedeveloped. He is nowrecognisedas a pioneerof antiseptic policyand
prevention of nosocomialdisease.
JosephLister(LordLister, 1827±1912) introduced antiseptic surgery.By the
middle of the 19thcentury,post-operativesepsis infectionaccountedfor the
deathof almosthalf of patientsundergoingmajorsurgery. A commonreportby
surgeonswas:operationsuccessfulbut patientdied.For manyyearshe had
explored the inflammation of wounds, at the Glasgow Infirmary. These
observationsled him to consider that infectionwas not due to bad air alone,
and that woundsepsis'was a formof decomposition.When,in 1865,Louis Pasteursuggested that decayin wounds was causedby livingorganismsin the air, whichon enteringmattercaused it to ferment, Listermade the connection withwound sepsis.As a meticulousresearcher and surgeon, Listerrecognised the relationship between Pasteur'sresearchand his own.He consideredthat microbes in the air were likely to be causing the putrefactionand mustbe destroyed beforethey enteredthe wound. In 1864Listerhad heard thatcarbolic
acid'was beingusedto treatsewagein Carlisle (UK), and that fieldstreated
withthe effluentbecamefree of parasitescausingdiseasein cattle.Evenbefore
the workof Pasteuron fermentation and putrefaction, Listerhad beenconvinced
of the importance of scrupulous cleanlinessand the usefulness of deodorants in
the operatingroom.In 1865he begansprayinga carbolicacidsolution during
surgeryto kill germs.In the end,Listergives Semmelweis his due by saying
`Without Semmelweis, my achievementswould be nothing'. ThroughPasteur's
researches,he realised that the formation of pus wasdue to bacteria,so he
Table1.1 Theeffectof hand-washingand hand-washingwithchlorinatedlimeon
maternaldeathcausedby puerperalfever
Year/period Maternaldeathrate in (%)
Medicalstudents Midwifestudents
(clinic1) (clinic2)
1841±1846 9.92 3.38
May 1847 12.42
Introductionof hand-washing
June 1847 2.38
July 1847 1.20
August 1847 1.89
Introductionof chlorinatedlimehand-washing
October 1847 1.27 1.33
March 1848 0 0
August 1848 0 0
Introduction 5