Biographical entry Lister, Joseph (1827 - 1912)
Baronet, 1883; Baron Lister of Lyme Regis, 1897; Privy Councillor, 1902; Order of Merit, 1902; MRCS, Dec 9th, 1852; FRCS, Dec 9th, 1852; BA London, 1847; MB, 1852; FRCS Edin, April 21st, 1855; FRS, 1860.
- 5 April 1827
- 9 February 1912
- General surgeon
Born on April 5th, 1827, at Upton House, Stoke Newington, then a pleasant suburb of London, the fourth child and second son of Joseph Jackson Lister and Isabella Harris. J Jackson Lister was a port-wine shipper in partnership with Thomas Barton Beck, of Tokenhouse Yard, the grandfather of Marcus Beck (q.v.). Joseph Jackson Lister (1786-1869) was the inventor of the achromatic objective used in modern microscopes, and was admitted a FRS on Feb 2nd, 1832. Like his wife and his partner he was a member of the Society of Friends. Isabella Harris, Lister’s mother, was the youngest daughter of Anthony Harris, a master mariner of Maryport, Cumberland. Before her marriage she had assisted her widowed mother, who was superintendent of Ackworth School, near Pontefract, in Yorkshire, a school intended for the education of the children of Friends who were “not in affluent circumstances”.
Joseph Lister was sent first to a private school at Hitchin and afterwards to the Quaker School kept by Mr Binns, of Grove House, Tottenham, where he got a sound classical education with some knowledge of comparative anatomy. From an early age he determined to become a surgeon, and he soon learned to macerate bones, dissect fish and small animals, and articulate their skeletons. He also showed some ability in drawing and sketching.
Lister entered the unsectarian University of London in 1844, taking the Arts course and graduating BA in 1847, with honours in classics and botany. He must also have visited the North London (now University College) Hospital, for he was [may have been] present on Dec 21st, 1846, when Robert Liston (q.v.) performed the first operation in London upon a patient anaesthetized with ether. During his undergraduate period he suffered from small-pox, followed by a nervous breakdown, leading to a long holiday, so that he did not begin his medical studies at University College until October, 1848. During his student career he took an active part in the Debating Society at University College and in the affairs of the Hospital Medical Society. He seems to have been influenced more especially by the teaching of Wharton Jones (q.v.) and William Sharpey, physiologists, and by Thomas Graham, the Professor of Chemistry; and in 1853 he published two papers based on experiments. The first confirmed Kölliker’s observations on the muscular tissue of the iris, in which he demonstrated the existence both of dilator and sphincter fibres; the second, on the involuntary muscle of the skin, showed the means by which ‘goose skin’ is produced. Both communications were illustrated by delicate camera lucida drawings such as his father had taught him to make. In 1851 he served as House Surgeon to Sir John Eric Erichsen (q.v.) after he had acted as House Physician to Dr Walter Hayle Walshe.
Lister had no definite plan for the future at the end of his house surgeoncy, and was advised by Professor Sharpey to visit Edinburgh, where James Syme (q.v.) had made a great surgical reputation, and then proceed to the Continental schools. He took the advice, went to Edinburgh, lodged in South Frederick Street, and presented himself to Syme in September, 1853. Syme at once took a liking to the young Quaker. He was invited to Millbank, Syme’s country house at Morningside, and became a regular attendant at the Royal Infirmary and Minto House, being sometimes allowed to assist at private operations. By the end of October Lister had determined to stay in Edinburgh through the winter, and in November Syme appointed him ‘Supernumerary Clerk’, a non-resident post which was much coveted. The duties were to assist at every operation, to watch the subsequent course of the case, and to take notes. During his term of office he read a paper at a full meeting of the Royal Edinburgh Medico-Chirurgical Society to show that cancellous exostoses ossified in the same manner as the epiphysial cartilages of long bones.
He was appointed Resident House Surgeon to Syme on his return from a Christmas visit to his family at Upton House in 1854, and held office until the end of February, 1855. Syme had by this time formed so high an estimate of his surgical ability that he gave Lister to understand that they stood in the relationship of Surgeon and Consulting Surgeon, and that he had authority to operate upon such emergency cases as he thought fit. This privilege was very unusual at a time when hospital surgeons were most averse to delegate any of the duties entrusted to them either in teaching, operating, or treatment. Lister made the best use of his opportunities, and his twelve dressers were not slow to appreciate their good fortune; to them he was always known as ‘The Chief’, whilst Syme was spoken of as ‘The Master’.
News reached Edinburgh in October, 1854, that Richard James Mackenzie, Surgeon to the Infirmary, and Lecturer on Surgery at the Edinburgh Extra-mural School, had died of cholera at Balbec on Sept 28th, whilst serving as temporary surgeon to the 79th Highlanders in the Crimean War. Lister determined to “take advantage of this unrivalled opportunity”, as he called it, hired a lecture-room at 4 High School Yards, was elected a Fellow of the Royal College of Surgeons of Edinburgh on April 21st, 1855, took lodgings at 3 Rutland Square, nearly opposite Syme’s consulting-room, and settled in Edinburgh to teach and practise surgery. He paid a hurried visit to Paris in June, 1855, to take a course of operative surgery on the dead body, returned to Rutland Square in July, and in August became engaged to Agnes, Syme’s elder daughter. The engagement led him to resign his membership of the Society of Friends and to become a Scottish Episcopalian, though he retained to the end of his life nearly all his Quaker characteristics. The wedding took place in Syme’s drawing-room at Millbank, in Scottish fashion, on April 23rd, 1856, and the marriage was supremely happy though there were no children. Lady Lister died of acute pneumonia whilst on a holiday at Rapallo on April 12th, 1893.
Lister gave his first lecture on the “Principles and Practice of Surgery” at 4 High School Yards on Wednesday, Nov 7th, 1855. In preparation for it he had carried out a series of researches - mainly on the web of the frog’s foot - to show the early stages of inflammation, the results of which he communicated to the Royal Society on June 18th, 1857. At the end of the session he made an extended tour with his wife, visited France, Germany, Switzerland, and Italy, making the acquaintance of many Continental surgeons. He returned to Edinburgh in October, 1856, rented a house, No 11 Rutland Street, and was unanimously elected Assistant Surgeon to the Edinburgh Infirmary on Oct 13th, 1856. He began his second course of lectures on Nov 15th, and again dealt with the pathology of inflammation, treating also of the coagulation of the blood and the effects of stimuli on the pigment cells of the frog. He dealt, therefore, with the institutes of medicine rather than with surgery: his class, though small, was appreciative.
James A Lawrie, Regius Professor of Clinical Surgery in the University of Glasgow, became an invalid in August, 1859. The Home Secretary, Sir George Cornewall Lewis - on the advice of Allen Thomson, Syme, and Robert Christison - nominated Lister to the post, for which there were seven candidates. The appointment was confirmed on Jan 28th, 1860, and Lister’s departure from Edinburgh was celebrated by a banquet and the presentation of a silver flagon. He inaugurated his appointment as Regius Professor of Clinical Surgery in the University of Glasgow by delivering a course of lectures to a class of 182 students. He had, however, no charge of beds, and it was not until Aug 15th, 1861 - nineteen months after his appointment to the Chair of Surgery - that he was elected Surgeon to the Royal Infirmary; nor then without some opposition.
As a result of his experiences as Surgeon at the Royal Infirmary at Glasgow Lister described and practised a new method of amputation at the knee, and invented a tourniquet for compressing the aorta during amputation at the hip and for use during ligature of the large arteries for aneurysm, which was then of frequent occurrence. He also devised a method for reducing the loss of blood during amputation by raising the limb for some minutes before a tourniquet was screwed home. He also invented a needle with an eye for passing wire sutures through the tissues.
Lister was elected a Fellow of the Royal Society in 1860 and delivered the Croonian Lecture in 1863, taking “Coagulation of the Blood” as the subject. James Miller, the Professor of Systematic Surgery at Edinburgh, died in 1864, and Lister was urged to apply for the Chair on the ground that it was held for life, whilst at Glasgow the Surgeon to the Infirmary could only be elected twice, each time for a period of five years, and he might thus again be left without a hospital appointment. Lister applied, but James Spence was elected. In this year he invented a simple instrument for removing foreign bodies from the external auditory meatus and described his well-known operation for excision of the wrist.
The year 1865 is memorable in the life of Lister because Dr Thomas Anderson, the Professor of Chemistry at Glasgow, drew his attention to Pasteur’s work which showed that putrefaction was due to living organisms in the air. In March, 1865, he used liquefied German creosote and then carbolic acid in the treatment of compound fractures, and he thus began the use of antiseptic surgery. The stages through which it passed were: crude acid in a watery solution; a purer acid dissolved in oil; a putty made by mixing common whitening with a 1-4 or 1-6 solution of carbolic acid in linseed oil; and finally a dressing of lint soaked in carbolized oil. The experimental dressings were carried out quietly in his ward at the Glasgow Infirmary until he published his epoch-making papers in the Lancet from March to July, 1867, under the title, “On a New Method of Treating Compound Fractures, Abscess, etc., with Observation on the Conditions of Suppuration”. He made his system still more widely known by reading a paper at the Dublin Meeting of the British Medical Association in August, 1867, “On the Antiseptic Principle in the Practice of Surgery”. He directed attention in it to three causes of suppuration: “(1) Simple inflammatory suppuration; (2) Suppuration caused by a chemical or a mechanical stimulus; (3) Suppuration caused by decomposition.” It does not appear as if he had yet thought of ferments or fungi as a cause.
In the summer of 1866 Lister applied for the post of Professor of Surgery at University College which had become vacant by the resignation of Sir John Eric Erichsen (q.v.), but John Marshall (q.v.), who had been Assistant Surgeon from 1847, was elected. From 1867-1869 Lister was occupied in experimenting with a variety of wound dressings whilst he continued to work at the Glasgow Infirmary and to give a daily lecture at the University to a crowd of enthusiastic students. Towards the end of this period he had learnt and accepted the germ theory of putrefaction. He tied the carotid artery of a horse with silk which had been soaked in carbolic acid on Dec 12th, 1867, and obtained union by first intention, and in December, 1868, he first used an absorbable ligature - catgut.
Professor Syme - his father-in-law - fell into ill health in 1869 and resigned his chair of Clinical Surgery at Edinburgh in July. Lister was appointed in his place on Aug 18th, his pleasure being marred by the death of his father on Oct 24th. Lister returned to Edinburgh directly after the funeral and took a furnished house at 17 Abercromby Square, moving afterwards to 9 Charlotte Square, then a fashionable and medical centre. Here he soon became known as the leading surgeon in Scotland and acquired a larger practice than at any other time of his life.
From 1873-1881 he was deeply interested in the effects of yeasts and micro-organisms on suppuration, and made a succession of changes in the dressings of wounds. He began to use the carbolic spray in 1871 and did not abandon it until 1887, although Sir John Burdon Sanderson had shown as early as 1873 that bacteria are not carried by the air and are killed by a dry heat of 100° C. In 1870 he employed many layers of carbolized gauze and a layer of ‘hat-lining’. In 1876 he used boric lint, on the suggestion of Louis Pasteur, as a dressing for wounds. In 1884 he used corrosive sublimate ‘blue’ wool and gauze and sal alembroth - a double salt of bichloride of mercury and chloride of ammonium. In 1889 he adopted a gauze charged with a double cyanide of mercury and zinc. He first used a rubber drainage tube in 1871, seemingly on his own initiative, though it had been employed by Chassaignac as early as 1859; his patient was Queen Victoria, upon whom he operated at Balmoral for an abscess in the axilla. He had been appointed Surgeon to the Queen in Scotland in 1870.
Sir William Fergusson (q.v.) died on Feb 10th, 1877, and as early as Feb 18th Lister had been approached as to his willingness to become Professor of Clinical Surgery at King’s College Hospital in London, to fill the vacancy thus created. John Wood was next in order of succession. He was appointed, and on June 18th, 1877, Lister was elected to an additional chair of Clinical Surgery and was given beds in the hospital. He resigned his offices in Edinburgh and came to London purely in a missionary spirit to advance the cause he had so deeply at heart, and took a house at 12 Park Crescent, Regent’s Park. He brought with him Sir W Watson Cheyne, who had been his House Surgeon; John Stewart, who afterwards practised at Halifax, Nova Scotia; W H Dobie, who lived afterwards at Chester; and James Altham, who spent his life at Penrith. In 1892 he resigned his office of Professor of Clinical Surgery at King’s College on reaching the age of 65, but was invited to continue as Surgeon to King’s College Hospital for an additional year.
At the Royal College of Surgeons of England Lister was a Member of the Council from 1880-1888, serving as Vice-President in 1886, but declining to be nominated for the office of President. He delivered the Bradshaw Lecture in 1887 “On the Present Position of Antiseptic Treatment in Surgery”. In 1897 he was given the Honorary Gold Medal, which is the highest distinction the College can bestow on its Members and Fellows. At the Royal Society he was elected a Fellow in 1860; served on the Council from 1881-1883; was foreign secretary from 1893-1895, succeeding Sir Archibald Geikie; and President in succession to Lord Kelvin from 1895-1900. He delivered the Croonian Lecture in 1863, was awarded a Royal Medal in 1880, and the Copley Medal in 1900.
He became Surgeon in Ordinary to the Queen in October, 1878, following John Hilton (q.v.), and Serjeant Surgeon in 1900 in place of Sir James Paget (q.v.). He was created a baronet in 1883, and received the patent of a baron as Lord Lister of Lyme Regis at Queen Victoria’s second Jubilee in 1897. On the coronation of King Edward VII he was chosen one of the twelve members of the newly established Order of Merit and was gazetted a Privy Councillor.
A British Institute of Preventive Medicine was established in London in 1891 on the lines of the Institut Pasteur in Paris and was called the Jenner Institute when it was opened in 1897, the name being changed in 1903 to “The Lister Institute of Preventive Medicine”. Lister was appointed the first Chairman of the governing body, and became President of the Institute when the present building was completed in 1910. The touching meeting between Lister and Pasteur at the Sorbonne took place on Dec 27th, 1892, and in January, 1896, Lister attended Pasteur’s reburial in the chapel at the foot of the Institut Pasteur.
In 1896 Lister gave an address as President of the Liverpool Meeting of the British Association; in the autumn of 1897 he visited Toronto in the same capacity; and in 1902 he made a voyage to South Africa. Most of the time from 1903-1907 was spent in London, where his household was superintended by his sister-in-law, Miss Syme; but he often paid visits to Lyme Regis in Dorsetshire, where he had bought a house in 1870 jointly with his brother Arthur and his brother-in-law, Smith Harrison.
Sight and hearing began to fail in 1909, and with gradually failing powers he died quietly of pneumonia on the morning of Feb 9th, 1912, at Park House, Walmer, Kent, without issue and the peerage ended. A stately Memorial Service was held in Westminster Abbey on Feb 16th and his body was buried by the side of his wife at the West Hampstead Cemetery, London.
Lister was 5 feet 10 inches in height, well formed and well proportioned; the head round, the forehead broad, full, and in later life rather wrinkled; the eyes blue and soft, the nose small but well formed; the lips full, especially the upper lip, the left half of which had a slight tilt; the mouth expressive of rare delicacy of feeling; the lower jaw strong; the complexion fresh and healthy; the lips and chin carefully shaven, the cheeks with ‘mutton-chop’ whiskers, as was the usual fashion of his generation; a fine head of hair - brown in youth - worn rather long and ending in light curls at the back. He spoke softly, frequently with a slight stammer; he sighed often and had a pleasant gentle smile, though he laughed but rarely. Equable in temper, he never spoke unadvisedly with his lips, even under great provocation, and seemed rather to pity than to be vexed with his opponents. He was courteous to all, but sheltered himself behind a natural reserve which many attributed to shyness. A lover of home life and very simple in his tastes, he maintained to the last evidence of his Quaker upbringing by using ‘thou’ and ‘thee’ when writing familiarly to members of his family. He was deeply religious, but without ostentation, attaching himself to no sect, but living a Christian life. No lover of money, he proportioned his fees to what he thought a patient could afford rather than what it was right or customary to charge, and he never, therefore, acquired wealth. He had square thick hands with rather short fingers, the skin being cracked and roughened by the constant use of carbolic solutions. He used his hands to good effect, but he was a slow operator, and in the face of any temporary difficulty during an operation he sweated profusely.
The British Medical Journal (1927, ii, 110) gives an account of the various portraits of Lister, with a full-page coloured plate of the portrait by J H Lorimer, RSA, dated 1895. A portrait by W W Ouless, RA, 1897, hangs on the staircase at the Royal College of Surgeons, and near it is a bust by Sir Thomas Brock, RA, who also executed the medallion in Westminster Abbey. A colossal bust by the same sculptor stands near the top of Portland Place in the centre of the roadway; it was executed in 1922.
The Lister Memorial Fund was raised by public subscription with the object of showing a lasting mark of respect to the memory of Lord Lister and in grateful appreciation of his eminent services to the science of surgery and the signal benefit thereby conferred on mankind. It consists of a general fund out of which a lecturer is paid once in three years, and a Bronze Medal which is awarded, irrespective of nationality, in recognition of distinguished contributions to surgical science. The Museum of the College also possesses a Lister Memorial Cabinet filled with various objects belonging to Lord Lister and collected by the assiduity of the late Sir Rickman J Godlee, Bart, KCVO (q.v.).
Many honours fell to Lister in addition to those already mentioned: FRCS Edin in 1855 and Hon in 1905; FFPS Glasgow, 1860 and Hon 1898; FRS and LLD, Edin, 1878; Hon MD Dublin, 1879; LLD Glasgow, 1879; DCL Oxon, 1880; LLD Cantab, 1880; DSc Vict, 1898; Hon MD, Würzburg, Bologna, Budapest, Geneva; Kt Grand Cross Ord Dannebrog; Kt Prussian Ord ‘pour le mérite’, 1885; Fellow of University College, London; Cothenius Med Germ Soc of Naturalists, 1877; Royal Medalist of the Royal Society, London, 1880; Copley Med, 1902; Laureate French Acad Sci and Bondet Prizeman, 1881; Mem Assoc de l’Institut de France; Mem Assoc de l’Académie de Méd, Paris; Hon Mem Amer Acad Arts and Sci, Med Socs Munich, Leipzig, Vienna, Budapest, Dresden, Amsterdam, Petersburg, and Finland, and Obstet Soc Leipzig; Corr Member Soc de Chirurg, Paris, etc; Emeritus Professor Clin Surg King’s College; Consulting Surgeon King’s College Hospital; a freeman of the City of London, June 20th, 1907, and of Edinburgh, Jan 22nd, 1908.
ANTISEPSIS ENSURING ASEPTIC SURGERY
Lister revolutionized the art of surgery and started an indefinite extension by inventing the first method through which a surgeon was able with certainty to prevent inflammation from disturbing the natural healing of a wound when made by the surgeon, as well as to restrict or even to prevent inflammation in an accidental wound. He achieved asepsis by using chemical antiseptics; subsequently an improved asepsis resulted from methods of sterilization by heat under pressure.
The use of antiseptics is as old as surgery itself. As employed by Hippocrates, ασηπτος referred to that which does not putrefy, the unputrefiable; αποσηπεσθαι had reference to the prevention of putrefaction in honey by cooking it; δνσσηπτος, putrefying with difficulty, was applied by Galen to linen and hemp for ligatures as opposed to catgut. The balsams, benzoin surviving longest; the caustics, including boiling oil; later the vegetable and mineral acids; and throughout the various forms of alcohol - all were used with the object of neutralizing the ill consequences of decomposition. Many experiments during the eighteenth and nineteenth centuries had for their object the estimation of the relative antiseptic properties of various substances.
In contrast with much popular opinion Ancient Medicine obstinately opposed the theory of contagion. The idea of contagion was discountenanced by medical authority, and philosophy firmly held that all infection, including that of wounds, was air-borne. Aristotle in one passage had named plague, phthisis, itch, and ophthalmia as diseases transmitted by contagion; but in another he had upheld spontaneous generation, the parasites of man generated ‘nits’ and the ‘nits’ generated nothing. The Hebrews, perhaps learning from Egypt, certainly believed in the contagion of leprosy and of venereal disease, and through flies. But there is no trace of such ideas in Hippocrates and his followers. The body parasites and flies were held to generate spontaneously until Redi in 1658 carried out before the Academy of Experience in Florence his experiment of preventing the development of maggots in meat if flies were kept away by fine wire netting.
Avenzoar described how the itch mites burrow under the skin, and this was demonstrated by experiment by Galés in Paris in 1812 and again by Renucci in 1834. But the old humoral pathology held sway, and in 1842 Hebra still maintained that there was a special itch dyscrasia which resulted in the spontaneous generation of the itch insect. After a further series of experiments in France, Hebra in 1844 changed his opinion and accepted the itch insect as the cause of scabies. Improvements in the microscope, to which Lister’s father contributed importantly, permitted the discovery of micro-organisms. The large Bacillus anthracis was seen in the splenic blood of infected cattle in 1855 by Pollender, it was proved by Davaine in 1863 to be characteristic of the disease, and later was stained by Koch, so as to be seen in tissues.
Fermentation attracted attention from earliest times in connection with the fermentation of wine, the leavening of bread, and the digestive processes in the stomach and intestines. Further, with the rise of chemistry came in a number of simple chemical reactions. By loose analogy these fermentations and reactions were transferred to the causation of disease and of inflammation in wounds. Liebig with other chemists adhered to old vague notions; putrefaction was attributed to an inherent tendency to decay, favoured by a supply of oxygen; any organisms appeared late and only modified the course of fermentation. The yeast organisms had been seen by Leeuwenhoek in 1680, and various observations followed until in 1844 Pasteur began to inquire into the correct fermenting of wine, and as to the production of tartar. Whilst he was continuing his observations the chief authorities in Paris were united in rejecting organisms as the cause of fermentation. In 1850 Claude Bernard at the Collège de France declared that the process of fermentation was an obscure one; in 1853 Dumas employed the same expression, ‘obscure’; Berzelius held it to be a catalytic process. It was in August, 1857, that Pasteur read to the Lille Scientific Society a paper on lactic acid fermentation by organisms, and in December, 1857, a paper to the Académie des Sciences on alcoholic fermentation and its relation to yeast globules.
As to anticipations of Lister, a most remarkable and curious account published in the Lancet (1912, i, 885) relates to the opinion of Randall, a London surgeon, as described by Mr Justice Street in charging the Jury at the Guildhall on May 4th, 1687. The judge said, “The plaintiff did naught save wash and tend the wound, for he saith that the pus which all others admire and desire as showing that Nature hath armed herself for the fight is not to be desired but that it is itself an impurity which should be avoided. He hath even in his mind some crotchet that pus is engendered by some small animal or plant, some bug or gnat, or beetle or fungus belike, though he saith openly that he cannot prove the existence of such creatures. This, however, he contendeth is because his glasses do not magnify sufficiently to see them. And he meaneth not the glasses or spectacles for weak or aged eyes, but the microscope which hath a rare and admirable faculty of making small things appear large. He saith forsooth that the true treatment is to keep all extraneous matter from the wound and even the air which he imagineth to be full of his bugs, gnats and beetles.” The surgeon was non-suited.
In 1860 Lister was appointed Regius Professor of Surgery in the University of Glasgow and Surgeon to the Glasgow Infirmary which had been built over the town pits filled with corpses during former epidemics. Naturally he taught that suppuration in wounds was due to decomposition brought about in some way by the air; the only alternative then held by many was that some change in the blood happened. He based his belief on experiences gained in the practice of subcutaneous surgery so-called, in the difference between the healing of a fracture uncomplicated by a wound and that of a compound fracture, between the healing after fracture of ribs with surgical emphysema following a crush, and that after a penetrating wound of the thorax.
At Glasgow in the years 1864-1866 Lister had a mortality after amputation of 45 per cent. In 1865, of 15 excisions of the wrist, 6 were attacked by hospital gangrene, and 1 by pyæmia. Within one week 5 men, following amputation, died of pyæmia; in six months (1865-1866) there were 13 deaths from pyæmia.
Lister, busily engaged on surgery, had not read widely; he had made no previous acquaintance with Pasteur’s researches until his attention in 1865 was drawn to them by his colleague, Thomas Anderson, Professor of Chemistry. He then learnt that putrefaction and fermentation were set up by the vitality of minute organisms suspended in the air, and that Pasteur had disproved the influence of oxygen and other gaseous constituents of the atmosphere. Neither had he heard of Semmelweiss, who had limited his statements to a cadaveric virus, and to a miasma given off from the bodies of lying-in women and their infants; he had made no point of a microbic infection. His ideas were opposed by German obstetric physicians and by Virchow. When poor Semmelweiss pricked his finger whilst operating on a new-born infant, the septic delirium which followed caused him to be sent into a lunatic asylum, where he died three weeks later of pyæmia. For a time his opinions were treated as those of a madman.
Neither had Lister learnt beforehand of Lemaire’s use of carbolic acid. Between 1860 and 1865 Lemaire, without a hospital appointment, and with no opportunities of applying it as a preventive in surgical operations, had used saponized coal tar, i.e., coal tar dissolved in a tincture of Quillaia saponaria (soapwort), in various ways as an antiseptic, for the reduction of inflammation and suppuration already established. All his observations were the reverse of methodical; the use had already been discarded before Lister took it up. Lister’s statement as to the adoption of carbolic acid was that in the course of the year 1864 he had been much struck with an account of the remarkable effects produced by carbolic acid upon the sewage of the town of Carlisle. He obtained the carbolic acid he first used from Professor Thomas Anderson. The material was dark and tarry from impurities, largely insoluble in water, and corresponded with what the Germans named creosote. He first made use of it in March, 1865. When first used for swabbing out a wound it proved unsatisfactory; next the carbolic acid was made to saturate lint, and some cauterization followed. Next carbonate of lead, glazier’s putty, was employed as an excipient applied between two sheets of calico.
His epoch-making paper “On a New Method of Treating Compound Fracture, Abscess, etc., with Observations on the Conditions of Suppuration” appeared in the Lancet from March to July, 1867. Note the use of the term ‘conditions’, and not of ‘causes’. Improvements in method were continuous; in 1867 Calvert, of Manchester, supplied pure crystalline phenol, and wounds were washed out with a 5 per cent solution of the pure phenol; silk ligatures, after being steeped in it, had their ends cut short and generally remained buried; the carbolic acid was mixed with melted shellac, 1-4, and spread on calico; over this was painted indiarubber dissolved in benzine; on evaporating it left a layer of indiarubber which prevented sticking. Immediately over the sutured wound a sheet of oil silk covered with gum copal was laid after it had been dipped in the carbolic acid solution to free it from organisms, and by this means irritation was prevented.
The above formed the essential antiseptic dressing in use when Lister left Glasgow for Edinburgh in the autumn of 1869. In an infirmary hitherto notorious for erysipelas, pyæmia, hospital gangrene, and tetanus, Lister had almost abolished such occurrences, whilst he had commenced to undertake surgical operations hitherto considered unjustifiable. The principle of Lister’s dressing was, by means of an antiseptic, to keep out the causes of putrefaction from entering wounds from the air, at the same time to exclude the antiseptic from the wound. There were two persistent misconceptions of Lister’s dressing: one that the dressing was intended to close up an operation wound; the ‘occlusion band’ idea was a cause of much misconception abroad. Lister’s dressing gave vent to any discharge, and when Sir James Paget painted collodion over a closed incision and then applied Lister’s dressing over it he courted the failure which ensued. The other misconception was that Lister’s method comprised the free application of carbolic acid to an operation wound, hence the number of carbolic acid poisoning cases which occurred under Billroth and Kocher.
Lister’s method was properly understood and followed with success by Bickersteth, of Liverpool, and others in this country, by Nussbaum, of Munich, and by R von Volkmann at Halle. Simpson, of Edinburgh, published cavilling articles against him. He made inapplicable references to Lemaire, germs were declared to be mythic fungi; he continued to advocate surgery in private houses in preference to hospitals, but this was countered by Prescott Hewitt’s note of twenty-three cases of pyæmia after operation in his private practice. Another cause of Simpson’s opposition was that Lister had not adopted his acupressure to which he had absurdly attributed a diminution of pyæmia at Aberdeen under Pirie. On the other hand, Lister adopted Simpson’s chloroform as an anaesthetic to the exclusion of ether.
In 1868 Lister entered upon a very complicated subject - the use of catgut instead of the carbolized silk. He used catgut steeped in carbolic acid dissolved in olive oil, which proved satisfactory in experiments on animals. In June, 1876, he began to prepare the catgut with chromic acid, later he added sulphurous acid, which gave the catgut a green tint such as he described in 1908. Of the innumerable alternative methods of sterilizing catgut, none proved free from occasional septic contamination by streptococcal germs and by those of tetanus.
At the outbreak of the Franco-Prussian War in 1870 Lister published A Method of Antiseptic Treatment applicable to Wounded in the War, which received no attention from either French or German surgeons. The immediate amputations practised by Wiseman and other English naval surgeons, and so extensively by Larrey, had been forgotten. William MacCormac (q.v.), the chief English surgeon, did not save a single case of amputation in French hospitals during the Franco-German War in 1870. Alphonse Guérin between September, 1870, and February, 1871, saved only one case of amputation. At the Hôpital Saint-Louis from March to June, 1871, he adopted Lister’s methods in a half-hearted sort of way, and out of 34 secondary amputations 19 survived.
Lister’s paper in 1870, “On the Effects of the Antiseptic System of Treatment upon the Salubrity of a Surgical Hospital”, marks the starting-point of a revolution in hospital construction, maintenance, and sanitation, which had often to be forced upon unwilling authorities. It is no wonder, considering the general state of hospital wards and the continual infection of wounds by erysipelas, pyæmia, and gangrene, that Lister should have introduced first the hand spray and then the steam spray. Already by 1881, when research by Tyndall and others had tended to exclude the air as a cause, and in view of Pasteur’s and Koch’s researches on micro-organisms, Lister had begun to contemplate the possibility of dispensing with the spray; he finally abandoned its use in 1887, and made an apology for its previous adoption at Berlin in 1890. Lister’s way of urging the practice of antiseptic surgery may be gathered from his introductory lecture at Edinburgh on Nov 8th, 1869: “On the Causation of Putrefaction and Fermentation”. Note the use of ‘causation’ as compared with the use of ‘conditions’ previously. He commended the germ theory to the Edinburgh students. “You are as competent as you ever will be to draw logical inferences from established data.”
In the course of a demonstration to members of the British Medical Association Lister remarked, “In order, gentlemen, that you may get satisfactory results from this sort of treatment, you must be able to see with your mental eye the septic ferments as distinctly as we see flies and other insects with the corporeal eye. If you can, you can be properly on your guard against them; if you do not see them, you will certainly be liable to relax in your precautions.” It is quite certain that disbelief among surgeons was largely occasioned because they had never themselves seen the objects under discussion. There is the tale of a senior at the meeting of the London Pathological Society asking what germs had to do with frogs; he had heard the term ‘bacteria’ used and he confused it with ‘batrachia’.
Two opponents may be mentioned: Spence, a colleague of Lister in Edinburgh, painted the skin of the margins of incisions with tincture of iodine. But there was really no comparison between the limited surgery practised by Spence and Lister’s extended field of operations. Savory at the Cork Meeting of the British Medical Association put forward 619 surgical operations carried out in the old way at St Bartholomew’s Hospital - a hospital where general cleanliness and sanitation were the best at that day. The operations had been followed by 45 deaths, a mortality of 7.2 per cent. But all the operations belonged to the limited class practised before Lister’s changes. Also the list included minor operations, 74 circumcisions, 25 tenotomies, 36 cases of fistula in ano, without deaths. Of 29 removals of the breast, with no deaths, the axilla was not opened in any one case; among 73 major operations there were 11 deaths and 13 excisions of joints with 4 deaths; Savory himself preferred amputation to excision. There were 9 deaths from pyæmia, 28 operation cases were attacked by erysipelas, and 4 died. The exclusion of the minor operations would render Savory’s statistics still more unfavourable.
Some use was made of Lister’s antiseptic method by Bergmann (q.v.) in the Russo-Turkish War of 1877. Among 81 severe gunshot injuries treated in this way the deaths numbered 15 (18.6 per cent), while among 143 similar severe gunshot injuries treated by older methods the deaths were 71 (49.6 per cent). Whereas immediate amputation had hitherto been the best treatment for a gunshot wound of the knee-joint, Bergmann saved cases without amputation.
In London, except by Howse at Guy’s Hospital, and by Marcus Beck at University College Hospital, Lister’s methods were but little understood or practised until after his removal to London as Professor of Clinical Surgery at King’s College Hospital in succession to Fergusson.
MacCormac’s Address at St Thomas’s Hospital on Dec 5th, 1879, and the debate which followed, exhibited the limited knowledge and the confusion in the minds of London surgeons opposing Lister. MacCormac mentioned as alternative antiseptics to carbolic acid, thymol, salicylic acid, boracic acid, acetate of alumina, and chloride of zinc. He did not refer to perchloride of mercury, with which in a 0.5 per cent solution Bergmann treated wool used for dressing in 1877.
Lister’s methods reached their acme at the London International Congress in 1881; Watson Cheyne gave a full account of them in his Antiseptic Surgery, 1882.
The further developments which replaced Lister’s procedure may be dated from Koch’s Untersuchungen ueber die Aetiologie der Wundinfectionskrankheiten, Leipzig, 1878, and his demonstrations at the London International Congress, including the staining of micro-organisms, and their cultivation on solid media, in test-tubes and on plates, in addition to fluid cultures in flasks. In 1881 Koch described perchloride of mercury as having a much more powerful influence in killing spores of anthrax than carbolic acid. That sublimate combined with albumin and so became much less active failed to prevent it from replacing carbolic acid, and its free application to fresh wounds resulted in numerous cases of mercury poisoning. The enhanced reputation of mercury salts led Lister to further research on the medication of dressings in order to avoid the irritation and pustulation produced by the perchloride. He tried the combination of mercury and ammonium chloride, sal alembroth, which proved too freely soluble after further research he adopted a double cyanide of mercury and zinc in 1889. Mercuric iodide was also introduced as a less poisonous solution than mercury chloride.
Then came the further researches by Pasteur, by Koch, and especially by pupils and followers of Koch who hunted out to their sources the causes infecting wounds; they distinguished in particular staphylococci and streptococci, and described methods of sterilizing by steam under pressure.
Pasteur attended a debate on puerperal fever in Paris, and declaring that none of the causes ascribed was the true one, went to the blackboard and drew micrococci in a chain as the real cause (see R F Godlee). Following up others, Fehleisen in 1883 demonstrated that erysipelas and allied infections were caused by streptococci. Alexander Ogston, whilst studying in Germany, showed that pus from acute suppuration in the hip-joint contained a pure cultivation of Staphylococcus aureus, and this organism proved to be the usual cause of suppuration and abscess, whilst the Staphylococcus albus was relatively inert. By 1878 Pasteur had come to recommend the flaming of instruments, and the sterilization of materials for dressings, etc., by heat at 1000-1200C under pressure. Neuber at Kiel, in private practice as a surgeon without hospital appointment, set himself to attain sterility of everything coming in contact with a wound, by boiling in the soft Kiel water instruments, dressings, clothing of patients, and overalls of surgeons and attendants. He washed out wounds with boiled normal salt solution. By 1885 he had set up a small private hospital having general sterility as its object. To hard water bicarbonate of soda was added. In 1886, Schlange having shown that dressing materials of commerce were nearly always contaminated by germs, Bergmann with his assistants, in particular Schimmelbusch, instituted the sterilizing procedures which were demonstrated at the Berlin International Congress in 1890. They used the bacillus of blue pus as a naked-eye indicator. Lister, whilst being shown round by Bergmann, noticed some beads of pus under the dressings, probably indicating imperfection in the sterilizing of the patient’s skin. The account by Schimmelbusch in his Antiseptische Wundbehandlung, 1893, and Rake’s English translation from the second German edition in 1894, popularized a procedure which replaced Lister’s methods up to the war of 1914.
Further research was made by a number of observers upon infection through the patient’s skin, the hands of the surgeons, his assistants and nurses, through the mouth and hair, and into the sterilization of catgut already mentioned. Cleansing of the skin by soap and water without scrubbing was shown to free it almost from infection, particularly in the delicate skin of children and the face and neck of adults; whereas more active scrubbing and treatment by carbolic acid or perchloride of mercury defeated the end in view by setting up dermatitis. A 2 per cent solution of iodine in rectified spirit painted once or at most twice upon clean skin came into general use. The hands and nails of the surgeon, his assistants and nurses were proved to require personal manicure. Sir Thomas Watson had suggested in a lecture the use of thin impervious leather gloves - to be destroyed at the end of the case - when attending a patient with puerperal fever. Mikulicz and others used cotton gloves, sterilized in boiling water, but being permeable they required to be often changed in the course of an operation. Halsted in the United States obtained the manufacture in 1891 of the rubber gloves which came into general use.
The great harm to the individual caused by oral sepsis was exposed in particular by William Hunter, Physician to Charing Cross Hospital. An enormous development occurred in the better care of the mouth demanded of surgeons and nurses; whilst provisionally the wearing of masks was a protection to patients, yet persistence of oral sepsis rebreathed by the masked surgeon was an added danger to him. Also the sterilization of anaesthetic masks was shown to be needed, and above all things, the necessity of putting the patient’s mouth in good order before undertaking operations. Hair kept clean was proved not to be a source of infection.
[Such is a summary of Listerism to the outbreak of the European War in 1914.]
Lister’s collected papers were published in two quarto volumes at the Clarendon Press, Oxford, in June, 1909, having been prepared by a Committee to celebrate his eightieth birthday on April 5th, 1907. There are two impressions, nearly the whole of the first impression having been destroyed by a fire at the printers.
Sources used to compile this entry: [Godlee’s Life of Lister, 1917, revised 1924. Godlee’s Six Papers by Lord Lister with a Short Biography, 8vo, London, 1921. Wrench’s Life of Lister, 8vo, London, 1913. Duke’s Lord Lister in the Roadmaker Series, 12mo, Boston and London, 1924. Logan Turner’s Joseph, Baron Lister, Centenary Volume, 4to, Edinburgh and London, 1927. Dict. Nat. Biog., 1912-21. Leeson’s Lister as I Knew Him, 8vo, London, 1927. Sir Hector C Cameron’s Reminiscences of Lister, 8vo, Glasgow University Publications, 1927, No. vi. Ashhurst, Annals of Medical History, New York, 1927, ix, 205. The Lister Number of the Brit Med Jour, 1902, ii, 1817, with a picture of the Lister frieze at the Policlinico Umberto and a bibliography of his papers to 1897. Encyclopœdia Britannica, 11th ed., 1911, and 14th ed., 1929. Sir William Watson Cheyne’s Lister and His Achievement, 8vo, 1925. The Lister Centenary Number of the Brit Med Jour, 1927, i, 653. Lister and the Lister Ward, 8vo, Glasgow, 1927. The ward was destroyed in 1924 and was reconstructed in the Wellcome Historical Medical Museum largely owing to the energy of C J S Thompson, MBE, who was then the Conservator. An account of the surgical instruments invented or used by Lister is given in C J S Thompson’s Guide to the Surgical Instruments and Objects in the Historical Series Museum, Royal College of Surgeons, England, 8vo, 1929, 62].
The Royal College of Surgeons of England
Created: 24 April 2008