Hong Kong Med J 2020 Jun;26(3):258–9 | Epub 3 Jun 2020
Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
COMMENTARY
COVID-19 and the history of antiseptic surgery:
how to tackle these little beasts
Teresa Tan, MB, ChB, FCSHK1; CH Yee, MB, BS, FCSHK2; CF Ng, MB, ChB, FCSHK, 2; Jeremy YC Teoh, MB, BS, FCSHK2
1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Prince of Wales Hospital,
The Chinese University of Hong Kong, Hong Kong
2 SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
Corresponding author: Dr Teresa Tan (teresa@surgery.cuhk.edu.hk)
![](https://www.hkmj.org/sites/default/files/mjimage/pdficon.png)
“Where are these little beasts? Show them to us, and
we shall believe in them.”1 These were the words John
Hughes Bennett said to Joseph Lister, challenging
his theory on aseptic techniques using carbolic acid.
In 1867, Joseph Lister first published an account
of his use of carbolic acid in a series of articles on
preventing wound infections in compound fractures
and abscesses.2 3 However, his theory of aseptic
techniques was mocked and widely criticised in his
early career; an article published in 1873 warned
the medical profession against Lister’s ideas of
antiseptics.4
Despite the negative comments and responses
from the medical field, Lister believed in his theory
and persevered.5 After many more publications
and meetings, his theory of antiseptic surgery was
eventually adopted. He gained recognition for his
works during his lifetime and was awarded the
Cameron Prize for Therapeutics of the University of
Edinburgh in 1890. Today, the name Joseph Lister
rings a bell for both surgeons and physicians alike,
and he is known as the father of modern surgery
or the pioneer of antiseptic surgery. His name can
also be found on a common household product:
Listerine mouthwash is actually named after Joseph
Lister!6
However, not all scientists whose brilliant
ideas got rejected survived to witness their theories
being put into practice. Take for example Ignaz
Semmelweis, a Hungarian obstetrician who first
proposed the idea that hand washing saves lives.7
In the early 1800s he noticed that the incidence
of puerperal fever could be lowered by the use of
disinfection. In 1847, his findings were published,
showing that when doctors washed their hands
before examining patients, the mortality rate for
women in his obstetrics ward was greatly reduced.8
He also published a number of studies showing that
hand washing could reduce mortality to below 1%.
Despite various publications by Semmelweis,
the medical community back then rejected his
ideas and theories.9 Doctors did not know about the
existence of germs, and Semmelweis could not offer
any acceptable scientific evidence for his findings. At that time, blood-stained hands and scrubs were
the proud battle marks of a busy and successful
surgeon, and many were offended by Semmelweis
suggesting for them to wash their hands. He was
heavily mocked by his peers. Nevertheless, the
outspoken Semmelweis continued to try to convince
the medical community to wash their hands, and
subsequently suffered a nervous breakdown, and
was sent to a Viennese asylum by his colleague
where he was held in a straitjacket. Sadly, he died 14
days later, most likely from beatings from the guards
that caused a gangrenous wound on his hand. What
made this tragedy even more tragic was that after
his death, the hospital that he worked at went back
to its old habits without hand washing, discarding
Semmelweis’ “crazy ideas”, and nobody cared that
mortality rates increased by a factor of six.
Semmelweis never lived to celebrate the
success of his theory. It was only decades later when
germ theory was described by Louis Pasteur and
Joseph Lister that it became accepted that antiseptic
techniques could indeed save lives. Semmelweis is
now recognised as a pioneer of antiseptic techniques,
and in 2008, he was selected as the motif for the
€50 Austrian commemorative coin, in a series that
celebrated physicians of Austria.
These two prominent physicians share
common traits: they both paid vigilant attention to
details of their patients, possessed inquisitive minds,
and were constantly questioning their own practices
and striving for improvement of patient care and
patient survival. Both conceived new concepts and
ideas, advocated for them to be put in place after
early clinical observations, and were initially rejected
by the medical community. It was only decades later
that their theories were put into practice and widely
talked about.
Fast forward to 2020, the most talked about
issue worldwide today is the coronavirus disease
2019 (COVID-19) pandemic which spread rapidly
internationally and caught many unprepared. Many
medical systems are overwhelmed and overburdened
by this sudden disease, and different countries have
adopted different practices to limit the spread. One hotly debated topic is whether to have the general
public wear masks, including handmade or reusable
masks. At the time of writing, there are no large-scale
studies to prove nor disprove the theory that this
“universal masking” can help contain and control
COVID-19. The general populations in Hong Kong,
China, and Taiwan and some other Asian territories
started wearing masks in early 2020. In contrast,
Western populations tend to follow official advice
that advocates mask-wearing only for the sick and
immunocompromised, and those working in close
proximity.
Observing the total numbers of COVID-19
cases, the disease somewhat seems better controlled
in countries/regions where mask-wearing is common,
such as Hong Kong, China, and Taiwan. As numbers
of confirmed cases of COVID-19 increased, some
countries such as the United States shifted towards
recommending mask-wearing in public areas. In
mid-April, Singapore made it mandatory to wear a
mask when stepping out of the house.10 Other virus-control
methods are also important, not least hand
washing, as well as social distancing, quarantines,
school closures, and restrictions on travel and mass
gatherings.11 It is difficult to identify whether one
measure is more effective than another in supressing
virus transmission, and most likely these measures
add up synergistically.
As the saying goes, “Prevention is better than
cure”. To tackle the worldwide problem of COVID-19, it may be worth considering universal masking to
control spreading of the disease. Despite the lack of
strong evidence to prove the effectiveness of universal
masking in preventing the spread of COVID-19, it is
a simple practice, and there is evidence that mask-wearing
helps control spread of aerosols.12
History has shown that it is not easy to change
one’s practice overnight, as shown by the lives of
Lister and Semmelweis. Yet, in today’s world where
COVID-19 caught us off guard, we need to be flexible
and think of feasible and practical methods to
control its spread. There is little doubt that universal
masking may be inconvenient and uncomfortable for
some, yet considering the human lives at stake, it is a
small inconvenience to help control the epidemic.
So, will universal masking help control the
spread of COVID-19? Only time will tell.
Author contributions
All authors contributed to the concept and design of the
study, drafting of the manuscript, and critical revision of the
manuscript for important intellectual content. All authors
had full access to the data, contributed to the study, approved
the final version for publication, and take responsibility for its
accuracy and integrity.
Conflicts of interest
As an editor of the journal, JYC Teoh was not involved in the peer review process. Other authors have no conflicts of
interest to disclose.
Funding/support
This commentary received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
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