Antisepsis is the destruction or inhibition of (slowing the growth of) microorganisms (very small living substances invisible without a microscope) that exist on living tissue. Antiseptics are the substances that kill or prevent the growth of the microorganisms. The name comes from the Greek words anti (against) and sepsis (decay). Antiseptics prevent infection and other changes in living tissue by destroying or slowing the growth of germs (microorganisms that cause disease). The nature and use of anti-septics was not fully understood until the discovery of bacteria.
When the skin is broken by a scratch or burn, microorganisms often begin to grow in the wound. Bacteria, viruses, and fungi that may be present on healthy skin can multiply rapidly where the skin is broken. Unless this growth is prevented or stopped, serious infection can take place. Organisms may also enter the body at the site of an injury and cause illness. To prevent this, antiseptics are applied to control the infective growth until the injury heals.
Since ancient times, physicians and healers have been aware of the anti-infective and anti-spoilage properties of certain substances. Egyptian embalmers (people who preserved and prepared bodies for burial) used resins (an organic substance taken from plants and trees), naphtha (a liquid hydrocarbon often used as a solvent or diluting agent), and liquid pitch, along with vegetable oils and spices. The effectiveness of this mixture is shown in the fine state of preservation of Egyptian mummies. Persian laws instructed people to store drinking water in bright copper vessels. The ancient Greeks and Romans recognized the antiseptic properties of wine, oil, and vinegar. The use of wine and vinegar in the dressing of wounds dates back to the Greek physician Hippocrates (460-377 B.C. ). Balsam, an antiseptic of both southeast Asia and Peru, was introduced to Europe in medieval times and remained in use through the 1800s.
A thirteenth-century surgeon, Theodoric of Bologna, recommended dressings dipped in wine to ward off the development of pus in wounds. English physician Sir John Pringle (1707-1782) published a series of papers entitled Experiments Upon Septic and Antiseptic Substances that contain one of the first uses of the word antiseptic. Genevieve Charlotte d'Arconville introduced the use of chloride of mercury as an antiseptic in 1766. After Bernard Courtois (1777-1838) discovered iodine in 1811, it became a popular antiseptic treatment for wounds.
None of these antiseptics, however, was sufficient to prevent the almost certain infection of wounds, particularly following surgery. Amputations, for example, were common in the 1800s, especially in the case of compound fracture (bone breaks that injure surrounding soft tissue). Amputations had a 40 to 45 percent mortality rate. The introduction of anesthesia in 1846 made the problem worse. It permitted more complicated and lengthy surgical operations, greatly increasing the likelihood of infection.
Another deadly form of infection was puerperal (occurring at the time of childbirth) fever, a streptococcus infection of the uterus that struck women who had just given birth. As more women gave birth at hospitals, epidemics of puerperal fever raced through maternity wards, sharply increasing maternal death rates. Most obstetricians (doctors who treat pregnant women) were baffled by the causes and possible prevention of this
Attempts to understand and stop puerperal fever brought about some of the early advances in antisepsis. In 1773 Dr. Charles White (1728-1813) of England recommended antiseptic injection in some cases of childbirth. Scottish physician Alexander Gordon (1752-1799) stated that obstetricians should wash their hands and clothes before treating patients. American physician and author Oliver Wendell Holmes (1809-1894) presented his conclusions about the spread of puerperal fever by unwashed doctors in 1843, while Hungarian doctor Ignaz Semmelweiss made the same discovery in 1847. When Semmelweiss required his students to wash their hands in an antiseptic chloride solution before examining patients, maternal death rates plunged from a high of 18 percent to a low of nearly 1 percent. Semmelweiss was correct about the transmission of infectious materials, but he could not explain what those substances were. Pasteur had part of the answer. In his studies of fermentation (organic transformation), Pasteur proved the existence of airborne microorganisms.
English surgeon Joseph Lister (1827-1912; professor at London's King's College Hospital) applied this new knowledge of bacteria to develop a successful system of antiseptic surgery. Concerned about the high rate of infection after surgery, Lister studied wound healing with the use of a microscope. After reading Pasteur's work, Lister concluded that microorganisms in the air caused the infection of wounds. Drawing on a report of the effects of carbolic acid on sewage bacteria, Lister developed an antiseptic system using the acid. He sprayed a wound and surrounding areas to destroy infectious organisms and also protected the area from new invasion by bacteria by using multiple-layer dressings. Lister first used the method successfully in an operation on a compound fracture of the leg in 1865.
Lister's antiseptic method was not simple, but it was effective. A published account of his successful application of the technique appeared in The Lancet in 1867 and ignited controversy (especially since Pasteur's germ theory of disease was still in dispute). Nevertheless, Listerian anti-septic surgery gained supporters worldwide, especially in Germany, where the technique was applied somewhat successfully in treating soldiers during the Franco-Prussian War (1870-1871). Doctors in the United States were especially resistant to the practice of antisepsis. Widespread acceptance came in the 1890s after German bacteriologist Heinrich Koch (1843-1910) effectively proved that germs cause disease.
A final obstacle to surgical antisepsis was the human hands. Although surgical instruments and dressings can be sterilized, surgeons' and nurses' hands can only be washed with antiseptics. An American doctor, William Halsted, solved this problem in 1890. Halsted received his medical degree from Columbia University in 1877. He returned to the United States from two years of study in Europe as a convert to the Listerian method of antisepsis. After breaking an addiction caused by his experiments with cocaine as an anesthetic, Halsted became chief of surgery at Johns Hopkins Medical School. There, he pioneered the use of rubber gloves in surgery to protect his head nurse, Caroline Hampton, from the antiseptic that was irritating her hands. Today sterile gloves are required during all surgical procedures.
Modern methods of preventing infection are very different from the techniques used by Lister and others. Antibiotics, penicillin, and sulfa drugs fight infection internally, and aseptic methods such as sterilization prevent bacteria from existing in a given area. Nevertheless, antiseptics continue to be important and are a lasting monument to Lister's vision. Among the most important used today are iodine, boric acid, and alcohol.