Lord Lister

LORD LISTER.

Early fifty years ago William Ernest Henley travelled from Gloucester to the Old Infirmary, Edinburgh. He was poor and friendless; already his disease had compelled the amputation of one foot, it was feared that he might lose the other, and he went to Edinburgh because, as he boldly announced on his arrival, other doctors considered Professor Lister "totally incompetent!"

The foot was saved; for twenty months Henley was Lister's patient at the Edinburgh Infirmary, and during this time he wrote the famous series of poems, In Hospital,  and this in a sonnet called The Chief—is the description he gives of Joseph Lister, Professor of Clinical Surgery:

"His brow spreads large and placid, and his eye Is deep and bright with steady looks that still. Soft lines of tranquil thought his face fulfil— His face at once benign and proud and shy. If envy scout, if ignorance deny His faultless patience, his unyielding will, Beautiful gentleness and splendid skill, Innumerable gratitudes reply. We hold him for another Heracles, Battling with custom, prejudice, disease."

It was fortunate for Henley (and for lovers of poetry) that he entered the Infirmary in 1873, instead of ten years earlier. Then, a sick man was safer in his own bedroom, or even in a schoolroom, a church, on a dunghill or in a stable, than in the hospitals built to relieve his sufferings. In the surgical wards, every patient was a victim of that terrible disease known as "hospital gangrene". Wounds, which to-day would heal cleanly and quickly, inevitably became poisoned, and it was only in the rarest cases that patients recovered from amputation. In 1847 chloroform was used for the first time; the result was—more operations, more gangrene Surgeons were in despair, but the first man to make his hospital sweet and clean, a place of healing instead of a danger to its inmates, was Joseph Lister, born at West Ham on April 5, 1827.

Lister's father was himself a distinguished Fellow of the Royal Society. "As a child he (the father) was shortsighted, and in order to see the landscape more comfortably from his nursery window he was accustomed to glue his eye to an air-bubble which had become imprisoned in the glass. The air-bubble acted as a lens, and enabled the boy to see the country with greater ease." I Later he "educed a common principle upon which the construction of the high-power lenses of the microscope have since been based . . . being the first man to establish a firm reputation upon a bubble".

He married in 1818 the daughter of a Cumberland Quaker, and Joseph was the second of seven children—an affectionate boy, high-spirited at home, shy with strangers, gravely conscientious. He was sent to a Quaker School, Grove House, Tottenham, and its records "give a picture of unerring and almost stupefying goodness. The masters were good, the boys were good . . . and he proved himself an able pupil, distinguished by thoroughness rather than brilliance." Both at school and at home, under his father's direction, Lister learnt to observe and accurately record; he was familiar with the microscope, and in 1844 he proceeded to University College, Gower Street. He matriculated in the following year, and later took the B.A. degree without gaining either honours or a gold medal. From University College he went direct to University College Hospital, and it was now that Lister began to show his worth. "Directly he entered medicine . . . he was recognized as the best student of his year, and it was clear that he was destined for high honours. The University examiners gave four gold medals. Lister procured two of them, and was very close to securing the other two." He took the degree of M. B. Lond. in 1852, and in the same year he was made a Fellow of the Royal College of Surgeons, but. what was more important, he came under the notice of William Sharpey, the most talented and original physiologist of his time.

As house-surgeon under William Sharpey, Lister became acquainted at University College Hospital with "the appalling forms of blood-poisoning, and above all the terrible disease . . . in which wounds that should heal cleanly became the centres of spreading mortification, and the living tissues rotted away with fearful rapidity. . . . The method in vogue was to put the patient under chloroform and burn the mortified flesh away with caustics. Sometimes this treatment was successful, sometimes in a few days the greyish film would appear at the edge of the wound again, presaging . . . death. But the very fact that the treatment was sometimes successful riveted the attention of the positive, constructive mind of Lister. To discover how that success was brought about, therein lay the clue to the disease and its conquest."

Putrefaction in wounds was then thought to be due to the oxygen in the atmosphere setting up "fermentation in the juices of the wound". Lister saw, however, that if it was possible to burn away the disease, something in the wound itself—not the oxygen in the air—was destroyed; that something  was the cause of the disease. Through his microscope he examined pieces of diseased tissue, and saw certain peculiar objects; he "held in his thought the possibility of a minute living organism as the local cause of the disease", but for the time being advanced no further. Winning golden opinions at University College, he went with an introduction from Sharpey to James Syme, one of the most famous surgeons of his time, and although Lister went to Edinburgh intending only to make a short visit, it was arranged that he should become Syme's house-surgeon in the Edinburgh Infirmary, and eventually he stayed in Scotland twenty-five years.

Lister was at this time a serious-looking, slender young man, of average height, graceful, with a large intellectual head. He dressed in black, wearing a high collar and black stock to show that, like his parents, he was a Quaker; he was fond of outdoor exercise, especially swimming, not quick to make friends, but impressing those with whom he came in contact by his "zeal and earnestness", and in 1856 he married James Syme's elder daughter, Agnes.

Till 1855 Lister had acted as Syme's house-surgeon; he then became assistant surgeon to the Infirmary, and once more attacked the problems which had aroused his curiosity at University College Hospital. First, he investigated the inflammatory condition which preceded putrefaction of the blood; he found, "by watching with the naked eye and the microscope, that what happened after something irritating had been applied to living tissues which did not kill them outright was: Firstly the blood-vessels contracted and their lumen became very small; the part became pale. Secondly, the vessels after an interval, dilated; the part became red. Thirdly, some of the blood in the most injured blood-vessels slowed down in its flow and coagulated; redness occurred which, being solid, could not be pressed away. Lastly, the fluid of the blood passed through the vessel walls and formed a 'blister' about the seat of injury." Touch your skin with a glowing match-head, and this process will become perfectly plain!

Why did the blood-vessels contract and dilate? Lister found, by a series of the most delicate and fascinating experiments, that "the clotting of the blood resulted from a direct and local loss of the vitality of the cells forming the inner lining of the blood-vessel . . . he determined therefore to keep wounds, whether accidental or operative, as free from any dirt, foreign matter, or rough handling as possible". In his experiments he had necessarily made use of dead substances as artificial irritants; but suppose there were "a living, minute, microbic enemy . . . whose attacks would vary, as everything that is living varies, and sometimes be long and protracted, sometimes suddenly fierce, sometimes slow but with outbreaks of ferocity? . . . What new weapons would be forged, what new defences erected, what new strategy and tactics devised!"

In 1860 Lister was appointed Professor of Clinical Surgery in the University of Glasgow. The wards were hotbeds of infection and pollution, and we need dwell on this gruesome subject only long enough to emphasize the changes that Lister effected. In the first place, he insisted on rigorous cleanliness in the wards and in the operating theatre. Lister used so many dressings that the authorities accused him of extravagance, till it was found that owing to the unusual cleanliness of the wards under his care the annual "spring-cleaning" was no longer needed. At that time surgeons neglected to wash their hands before operating because "they would so soon be dirty again". The house-surgeon would go his rounds, his lancet in his coat-pocket, and to the same pocket it would be returned, after use, unwashed. Twenty-five out of every hundred patients in the 'Hotel Dieu' at Paris never left it alive, and at one time in the great hospital at Munich eighty out of every hundred surgical patients were seized with this terrible pestilence, hospital gangrene.

Lister was the first man to insist that its ravages were not necessary, that it was not natural for wounds to suppurate—unless they were irritated—and meantime, "always on the lookout for aid," he read every scientific book, in English, French, or German, on which he could lay his hands, and at last, in the work of Louis Pasteur, he found the answer he sought.

He saw that innumerable tiny enemies were awaiting the paralysis, or loss of vitality, of the living tissues; that when, through an accident or an operative incision, these tissues were no longer able to defend themselves, microbes began their dreadful work. Of all his contemporaries, he was the only surgeon ready to receive enlightenment, to see Pasteur's work "in the light of a first principle", and he had now to seek some chemical which would kill the microbes setting up putrefaction.

Carbolic acid had already been used to destroy the odour of sewage, and Lister immediately concluded that it destroyed the odour by killing the causes of putrefaction, namely, the microbes. He therefore used carbolic acid in his first attempts of the new treatment, and a very disagreeable-looking fluid it was, dark and tarry. Its effect was to cause bleeding of the wounded edges—blood, mingling with the carbolic acid, formed a hard antiseptic scab, and neither air nor dirt could pass to the paralyses tissues incapable of defending themselves.

His first indisputable success came in 1865; a little boy had been run over by a cart, and one of the broken bones protruded through the skin of his leg. Lister dressed the wound with a piece of lint, soaked in carbolic acid; the bones were set, and the leg put into splints. Instead of suppuration, fever, and pain, the child was cheerful and healthy; he rapidly recovered. But in the next case Lister met with disappointment. All went well till he was called away from Glasgow for a few weeks; the patient—he had been kicked on the leg by a horse—was supposed to be recovering, except for a small superficial sore, due to irritation set up by the crude carbolic acid. No sooner was Lister absent than poison seized on this, and the patient recovered only after amputation of his leg, and a long, serious illness. It was necessary that Lister, and he alone, should conduct the new treatment; gradually, however, he trained nurses and students in his methods, and presently was able to announce, in 1866, that seven out of thirteen patients who had undergone antiseptic treatment had recovered without suppuration  . . . a success wholly unprecedented. Two out of the thirteen had died; two had suffered from hospital gangrene, but recovered; two had slight skin wounds which Lister did not consider sufficiently important to include, but the seven remaining cases "constituted the dawn of a success which grew quickly to the midday of a complete triumph."

Speaking in 1870, Lister declared that when his antiseptic system had been nine months in operation not a single case of hospital gangrene had occurred in his wards, and this seemed the more extraordinary since it had recently been discovered that a few inches below the ground, on a level with the floor of the two lowest accident wards, was "the uppermost tier of a multitude of coffins which had been placed there at the time of the cholera epidemic of 1849". Nevertheless Lister made his wards "models of cleanliness".

In 1869 James Syme suffered from an apoplectic stroke, but recovered sufficiently to insist that Lister should fill the post which he was compelled to resign. Lister therefore became Professor of Clinical Surgery at Edinburgh He purged the new wards as he had purged the old, and Henley was only one of many who might have said—

"His wise-rare smile is sweet with certainties, And seems in all his patients to compel Such love and faith as failures cannot quell."

He was never known to speak sharply or hastily either to nurse or dresser or student; but by members of his own profession (especially by the famous surgeon Sir James Simpson) Lister was bitterly attacked. First he was ignored, then slighted, lastly it was declared that his discoveries had been anticipated and that he was "strutting in borrowed plumes". Gradually, very gradually, the good news spread; other doctors tried Lister's methods with surprising results, but though at the outbreak of the Franco-Prussian war he published a pamphlet advising a simple antiseptic treatment for wounds, in the face of strong opposition he could do nothing; the treatment was as yet too new, and it was not until Lister became Professor of Clinical Surgery at King's College Hospital, London, that his doctrines found general acceptance.

In 1877 he left Edinburgh; he had insisted upon being allotted separate wards at King's College Hospital, to which he could appoint Edinburgh nurses and dressers, and at first it was a melancholy experience. No patients came! Lister's lecture-rooms had been crowded with eager students at Edinburgh, now twelve or twenty listless men lounged into the hall to hear this new professor; but it was only a question of weeks. By and bye opportunities came; Lister forced his colleagues to open their eyes, and in two years London surgeons congratulated him on "a signal triumph of that great principle in surgery, which had been accepted everywhere else almost before it was even listened to in London".

By this time Lister had convinced himself that a solution of carbolic acid in twenty parts of water, "while a mild and cleanly application, may be relied on for destroying any germs that may fall upon the wound during an operation." Originally he had spread carbolic putty, made from chalk and carbolic oil, upon thin metal sheets, and placed this dressing on the wound to serve as an artificial scab; later he spread the putty on stiff calico, but neither of these "plasters" proved entirely satisfactory, and he experimented with various materials, even trying a dressing of oakum, and eventually he sat up all night in his house in Charlotte Square, Edinburgh, preparing "antiseptic gauze". Cheap muslin was dipped in a mixture of shellac, paraffin, and carbolic acid, and at the infirmary next morning Lister explained to his students the meaning of its "constituents and manufacture". Later still he finally produced the bland, double cyanide of mercury and zinc gauze. This is to-day the most perfect antiseptic gauze in existence. It is the first field dressing which our soldiers carry to battle, sewn into their tunics, ready for emergency. The gauze is covered with a pad of cotton wool and the whole kept firmly in its place by bandages.

In 1879 Lister was fifty-two years of age; the antiseptic system had been finally accepted, and in his house in Park Crescent overlooking Regent's Park he continued his researches. He became Sergeant-Surgeon to Queen Victoria, and in 1,897 she raised him to the Peerage. It is interesting to notice that on one occasion Lister and Louis Pasteur met in Paris, at the celebration of Pasteur's Jubilee; they met on other occasions, but then, unable to control his emotion, Pasteur embraced him before the huge audience thundering applause. His married life has been described as "a life-long honeymoon"; unfortunately there were no children, and Lister did not long survive his wife. He died at Walmer on February 19, 1912, and was buried in Hampstead Cemetery.

It was Joseph Lister who made modern surgery possible. Before his time abdominal operations had been out of the question, but Lister knew how to combat the foes which attack paralysed tissues, he knew how to rob the battlefield of one of its worst horrors—gangrenous wound's—and he knew how to destroy, in crowded cities, the dangers that civilization has brought us. Nobody now questions the supreme value of Lister's discoveries, and in the present, as in the future—further than we can see—"innumerable gratitudes reply. . ."