Cold Open

It’s August 12th, 1865, at the Glasgow Royal Infirmary in Scotland.

Writhing in pain on a filthy bed, 11-year-old James Greenlees clenches his jaw.

He’s just arrived at the hospital with a broken leg. He fell in front of a passing wagon and has a compound fracture of the tibia. The bone is exposed through torn flesh, leaving James in agony.

The hospital around him reeks of sweat, vomit, and rot.

A surgeon passes by, heading to the operating theater, his hands and apron covered in dried blood.

James turns his head away, fixing his gaze on the ceiling. He’s only just a boy, but he’s smart enough to know that soon, he’ll be wheeled into that dreaded operating theater where a surgeon will saw off his leg. If he doesn’t bleed out on the table during the amputation, recovery will be just as risky. There’s a 50-50 chance he will die from infection.

But as James contemplates his grim fate…a new figure approaches. Joseph Lister is a 38-year-old British surgeon. Gentle and unassuming, Joseph kneels beside James and suggests a radical plan to save not only his life but his leg as well.

Joseph calmly tells the nurses that they’ll set James’ broken bone with splints. The staff hesitates, convinced that attempting to save this mangled leg will inevitably result in a deadly infection.

But Joseph is unwavering. After setting the bone, he says they’ll wrap the wound in lint soaked in carbolic acid.

Joseph believes this acid will kill the invisible agents that cause infection, allowing time for James’ bone to fuse and for the wound to heal. The nurses exchange uneasy glances. But James looks back at Joseph and nods. James may not fully understand Joseph’s plan, but if there’s any chance he can avoid the operating theater and keep his leg, he’ll take it.

Six weeks later, James Greenlees will do the unthinkable: he’ll walk out of the Glasgow Royal Infirmary on two legs. In an era when hospitals are known as “Houses of Death,” it will be nothing short of a miracle.

James was saved by Dr. Joseph Lister’s revolutionary antiseptic techniques. But he will be just the first of thousands. In the future, Joseph’s methods of sterilizing wounds, tools, hands, and operating environments will save countless lives and earn him the title, “the father of modern surgery.”

But before it gains widespread acceptance, Joseph’s innovation will face resistance and mockery from the medical establishment, even after the first application of antiseptic techniques on James Greenlees on August 12th, 1865.

Introduction

From Noiser and Airship, I’m Lindsay Graham, and this is History Daily.

History is made every day. On this podcast—every day—we tell the true stories of the people and events that shaped our world.

Today is August 12th, 1865: The First Antiseptic Surgery.

Act One

It’s January 1851, at University College Hospital in London, fourteen years before the miraculous recovery of James Greenlees.

In a chaotic surgical ward, 23-year-old medical student Joseph Lister rushes to his next patient. Around him, nurses hurry from bed to bed, while a staff member pushes a corpse out of the room on a gurney. Joseph only recently started this post, and he still hasn’t gotten used to the rancid smell, but he can’t let that slow him down. The surgical ward is always busy, and today, it’s in full crisis.

A few days ago, a man was taken in from a local workhouse, an institution that provides shelter for the poorest and most desperate in Victorian society. He’d been suffering from a dangerous and highly contagious skin infection. Hospital policy demands swift isolation in such cases, but this patient was mistakenly allowed to spend two hours in contact with other people on the general surgical ward. By the time he was finally moved to isolation, it was too late.

The patient who’d been in the bed next to him was the first to contract the illness. He had been recovering well from an operation, but his condition rapidly deteriorated once the infection took hold. By the time he died, eleven others in the general ward were also infected. Four of them die. Now, the fear is that there will be more infections. But there’s nowhere else for these sick people to go.

Joseph stands over a young woman who has just come out of surgery. She isn’t infected yet, and he quickly begins wrapping and dressing her wound.

In recent years, there has been a revolution in surgery, and Joseph has witnessed it firsthand. Five years ago, he watched the first operation in Europe conducted under general anesthetic. Before anesthesia, it was common for spectators to buy tickets to operating theaters, drawn to the terrible drama of watching screaming patients under the knife. Now, operating theaters are calmer places, and longer, more intricate surgeries are possible. But anesthesia can only deal with the pain. It does nothing to prevent what nearly always comes next: the infection, a killer that takes almost half of patients who undergo major operations.

In his job as a wound dresser, Joseph has already seen countless patients come out of successful surgeries, only to then die an agonizing death. So as Joseph tends to the patient in front of him today, he hopes she won’t be the latest to succumb to infection. No doubt, she’d have preferred the surgery to take place at home on her kitchen table, where the survival rates are much better. But most of Joseph’s patients are here in the hospital because they can’t afford that.

Joseph’s superior passes by and orders him to wrap the wound tighter to block the “bad air” that's spreading through the ward. This surgeon believes in the prevailing miasma theory of disease and infection. According to this theory, it’s “bad air” rising from decaying matter that causes disease. It’s why many surgeons don’t wash their hands and think nothing of using dirty tools and knives stained with blood from previous operations. After all, if disease is spread through the air, there’s no point in wasting time cleaning tools. But Joseph can’t help but wonder if this miasma theory could be wrong and if there isn’t another explanation for infection.

Joseph was raised to ask questions. His father, Joseph Jackson Lister, was a scientist who invented a new and more advanced kind of microscope. And growing up, Joseph was always taught that theories can be improved and scientific knowledge deepened. That curious attitude carried him far, and when he went away to medical school, he became a star pupil, winning honors in several subjects.

Now, as he works in the surgical ward, he's begun to notice a pattern: patients immediately after surgery are more likely to get infected than those who are already healing. As Joseph dresses wound after wound, he develops a quiet obsession. He wants to understand the invisible forces that are infecting his patients, and he wants to defeat them.

It’s the beginning of a journey of discovery that will one day change the world. Still, Joseph’s first breakthrough won’t come for another decade. And when it does, the lead will come from an unexpected source—not from a surgeon or any other kind of doctor, but from a French chemist studying milk and beer.

Act Two

It’s 1864 in Glasgow, Scotland, thirteen years after Joseph Lister’s first job as a wound dresser.

As the sun sinks toward the horizon, Joseph begins his walk home through the grounds of the city’s university. Joseph is now a professor here. And just as he’s passing through a stone archway, a shout echoes across the courtyard behind him. Joseph turns to see a colleague hurrying to catch up. Thomas Anderson is a chemistry professor and a good friend. They often walk home together. And today, as they amble through the Glasgow streets, Thomas asks Joseph if he’s heard of Louis Pasteur. Joseph shakes his head, no.

Thomas begins to explain. Pasteur is a promising young French chemist who’s studying the fermentation of beer and milk. He’s discovered that fermentation slows when milk is protected from the air. Pasteur believes that this shows that spoilage is caused by tiny living organisms in the air. He’s even gone as far as to suggest that these “microbes” could also cause disease.

Joseph stops walking. His mind flashes back to his days as a medical student working as a wound dresser. He remembers his observation that fresh wounds were more susceptible to infection. Maybe these “microbes” are better at penetrating open wounds than healing ones.

Thomas sees Joseph light up, but he warns that Pasteur’s ideas are controversial. Many scientists still cling to the prevailing theory that bad air is released from within decaying matter, whether spoiled milk or a festering wound. The idea that invisible, living things are floating through the air all around them seems absurd.

But this doesn’t quell Joseph’s excitement. Joseph is not only a professor, but also a practicing surgeon. And he can’t help but think, how he might apply Pasteur’s theory to save his patients.

So when he gets home, he eagerly discusses it all with his wife, Agnes. By the standards of the day, theirs is an unusual marriage. She’s more than his partner in life; she’s also his partner in medical research. Their home is no ordinary townhouse either: the first floor is a consulting room for patients, the second a laboratory, and the third their living quarters.

So, Joseph explains to Agnes that if Pasteur is right and harmful invisible organisms in the air are responsible for disease, then infection is preventable. It isn’t “bad air” that erupts spontaneously from decaying matter they’re fighting. It’s microscopic life that’s the real enemy.

Agnes’s eyes flash with understanding. And over the following months, the couple digest Pasteur’s papers and test germ theory in the context of hospital disease. Microscopes are now advanced enough to see bacteria, but it is difficult to distinguish between bacteria naturally present in wounds and those that cause infection. But despite these challenges, Joseph and Agnes work diligently to assemble evidence that diseases are caused by microbes. The next step is figuring out how to stop them.

In his work, Pasteur used heat to sterilize liquids. But doctors can’t boil the human body. They need something else, and Joseph has an idea. If heat can kill microbes, surely a chemical might do the same. They’ll just need to find the right one.

The answer arrives months later. One morning, Joseph is reading the newspaper when he comes across an article about the town of Carlisle, just across the border in England. Officials there are treating sewage with a substance called carbolic acid. It seems to eliminate the smell. They’ve also irrigated land with the acid, which has reduced instances of disease in both livestock and humans who live in the area. Intrigued, Joseph asks his chemistry colleague Thomas to obtain a supply of carbolic acid, and soon, Joseph and Agnes begin to experiment.

They make dilutions with linseed and olive oil, then try soaking silk and linen dressings in the acid. Over the next weeks and months, they run countless experiments and slowly refine their methods, waiting for the moment they can finally apply their new techniques on a patient.

That moment arrives on August 12th, 1865, when 11-year-old James Greenlees is brought into the Glasgow Royal Infirmary. A crushed leg would normally require amputation. But instead, Joseph cleans the wound, sets the bone, and applies dressings soaked in carbolic acid. Then he waits.

Four days later, Joseph peels back the dressings. And he isn’t hit with any stench; he doesn’t see any of the usual pus. The boy’s flesh isn’t red or inflamed. It's pink and healing. Nurses and other doctors rush over. Some stare in silence. Others whisper in disbelief. Because it seems like a miracle. Though Joseph knows it’s just science.

Two years later, in 1867, Joseph publishes a landmark paper in The Lancet, Britain’s most prestigious medical journal. Titled Antiseptic Principles of the Practice of Surgery, this paper discusses James Greenlees and other patients treated with carbolic acid dressings. The impact of this technique is astounding. By 1869, surgical mortality in Joseph’s ward had fallen from 45% before he started using carbolic acid to just 15%.

Even so, the medical world will not rush to adopt Joseph’s techniques. His ideas will be too new, too at odds with the widespread beliefs of the time. That is, until one very powerful woman demands Joseph prove himself in the most high-stakes operation of his career.

Act Three

It’s September 4th, 1871, at Balmoral Castle, a royal residence in the Highlands of Scotland, four years after Dr. Joseph Lister published his paper on antiseptic surgery.

Joseph grips his doctor’s bag tightly as a footman leads him through the halls of the castle, up a stairway, and into the bedroom of the most powerful woman on the planet.

Queen Victoria lies in bed, groaning in pain. Quietly, Joseph approaches and begins his examination.

Since developing his antiseptic techniques, Joseph has faced skepticism and mockery from some parts of the medical world. He’s not a natural advocate for his research, and he's often struggled to find the right words to promote it internationally. As a result, doctors in America remain especially dismissive, continuing to cling to their old ways. But in Scotland, Joseph’s results speak for themselves, and he has now been summoned to Balmoral Castle by the royal physician himself. A large lump has formed underneath the Queen’s arm, and Joseph is to remove it.

Joseph and his staff prepare for the operation in one of the queen’s living quarters. Since Joseph first started applying acid-soaked linens to wounds, he has expanded his methods. He now soaks his instruments in carbolic acid and sprays the air with it both before and during surgery to ensure everything is as sterilized as possible. Then, when everything is ready, the Queen is administered chloroform, she sinks into a deep sleep, and Joseph makes the first incision.

When the Queen wakes, Joseph tells her that the lump was removed successfully, but that the coming days and weeks will be critical. The wound must heal without any infection. So, Joseph tends to the Queen personally. Every morning, he changes her dressings, meticulously applying his carbolic solutions. Days pass, then a week without any swelling or fever. The wound remains clean as it heals. Joseph has saved Victoria’s life.

The Queen’s recovery becomes a powerful public endorsement, not just of Joseph’s antiseptic techniques, but of the radical new theory that disease is caused by invisible microbes called germs. There is still skepticism in some quarters, but more and more doctors and scientists now start to embrace Joseph’s way of thinking.

And over the years that follow, surgeons and medical students from around the world flock to watch Lister in his operating theater. Hospitals begin to transform. Instruments and environments are sterilized. And wounds are dressed with antiseptic care. As these practices spread, infection rates plummet, as do fatalities.

Then, in 1879, across the Atlantic, a Missouri chemist formulates a new antiseptic mouthwash. He names it Listerine in tribute to the surgeon who transformed modern medicine. The mouthwash will become a recognized brand around the world, but that won’t be Joseph Lister’s true legacy. Since the 19th century, his contributions to medical science have saved countless lives, beginning with James Greenlees, who underwent the world’s first antiseptic surgery on August 12th, 1865.

Outro

Next on History Daily. August 13th, 1906. A shooting in Brownsville, Texas, leads to the largest dismissal of soldiers in the history of the U.S. Army.

From Noiser and Airship, this is History Daily, hosted, edited, and executive produced by me, Lindsay Graham.

Audio editing by Muhammad Shahzaib.

Supervising Sound Designer Matthew Filler.

Music by Thrumm.

This episode is written and researched by Olivia Thomas.

Edited by William Simpson.

Managing producer Emily Burke.

Executive Producers are William Simpson for Airship and Pascal Hughes for Noiser.