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Joseph Lister Lister
1911 Encyclopedia Britannica
or Was thus early led to suspect the parasitic nature of the disorder, and searched with the microscope the material of the spreading sore, in the hope of discovering in it some invading fungus; he soon convinced himself of the cardinal truth that its causes were purely local. He also minutely investigated cases of pyaemia, another terrible scourge of hospitals at that time, xvt. 25 a and made camera lucida sketches of the appearances revealed by the microscope.
To realize Lister's work it is necessary to remember the condition of surgical practice at that date. About the middle of the 1 9 th century the introduction of anaesthetics had relieved the patient of much of the horror of the knife, and the surgeon of the duty of speed in his work. The agony of the sufferer had naturally and rightly compelled the public to demand rapid if not slap-dash surgery, and the surgeon to pride himself on it. Within decent limits of precision, the quickest craftsman was the best. With anaesthetics this state of things at any rate was changed. The pain of the operation itself no longer counted, and the surgeon was enabled not only to be as cautious and sedulous as dexterous, but also to venture upon long, profound and intricate operations which before had been out of the question. Yet unhappily this new enfranchisement seemed to be but an ironical liberty of Nature, who with the other hand took away what she had given. Direct healing of surgical wounds ("by first intention"), far from being the rule, was a piece of luck too rare to enter into the calculations of the operator; while of the graver surgical undertakings, however successful mechanically, the mortality by sepsis was ghastly. Suppuration, phagedaena and septic poisonings of the system carried away even the most promising patients and followed even trifling operations. Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, dreaded the very name of hospital, and the most skilful surgeons distrusted their own craft. New hospitals or new wards were built, yet after a very short time the new became as pestiferous as the old; and even scrupulous care in ventilation and housemaids' cleanliness failed to prevent the devastation. Surgery had enlarged its freedom, but only to find the weight of its new responsibilities more than it could bear.
When Lister was appointed to the chair of surgery in Glasgow the infirmary of that city was a hotbed of septic disease; so much so that his hospital visits evidently distressed him greatly. Windows were widely opened, piles of clean towels were supplied, but still the pestilence stalked through the wards. The building stands to-day as it stood then, with no substantial alteration; but by the genius of Lister its surgical wards are now as free from septic accidents as the most modern hospital in the land. James Simpson, early in the 'sixties, pathetically denounced the awful mortality of operations in hospitals, and indeed uttered desperate protests against the hospital system itself; yet, not long afterwards, Lister came to prove that it was not in the hospital that the causes of that mortality lay hidden, but in the operator himself, his tools and his assistants. Happily this beneficent discovery was made in time to preserve the inestimable boon of the hospital system from the counsels of despair. When Lister took up the task speculation was on the wrong tack; the oxygen of the air was then supposed to be the chief cause of the dissolution of the tissues, and to prevent access of air was impossible. For instance, a simple fracture, as of a bone of the leg, would do perfectly well, while in the very next bed a compound fracture - one, that is, where the skin is lacerated, and access to the seat of injury opened out - would go disastrously wrong. If the limb were amputated, a large proportion of such cases of amputation succumbed to septic poisoning.
On graduation as bachelor of medicine, Lister went to Edinburgh, where he soon afterwards became house-surgeon to Mr Syme; and he was much impressed by the skill and judgment of this great surgeon, and also by the superiority of his method of dressing recent wounds with dry lint, as compared with the "water dressing" in use at University College. Yet under these more favourable conditions the amelioration was only one of degree; in most wounds indeed "union by first intention" was rendered impossible by the presence of the silk ligatures employed for arresting bleeding, for these could come away only by a process of suppuration. On the expiry of his housesurgeoncy in Edinburgh, Lister started in that city an extraacademical course of lectures on surgery; and in preparation for these he entered on a series of investigations into inflammation and allied subjects. These researches, which were detailed fully in three papers in Phil. Trans. (1859), and in his Croonian lecture to the Royal Society in 1863, testified to an earnestness of purpose, a persevering accuracy of observation and experiment and an insight of scientific conception which show that if Lister had never developed the aseptic method of surgery, he would have taken a very high place in pathology. In his speech in Paris at the Thirteenth International Congress of Medicine in 1900, Lord Lister said that he had done no more than seize upon Pasteur's discoveries and apply them to surgery. But though Lister saw the vast importance of the discoveries of Pasteur, he saw it because he was watching on the heights; and he was watching there alone. From Pasteur Lister derived no doubt two fruitful ideas: first, that decomposition in organic substances is due to living "germs"; and, secondly, that these lowly and minute forms of vegetable life spring always, like higher organisms, from parents like themselves, and cannot arise de novo in the animal body. After his appointment to the Glasgow chair in 1860, Lister had continued his researches on inflammation; and he had long been led to suspect that decomposition of the blood in the wound was the main cause of suppuration. The two great theories established by Pasteur seemed to Lister to open out the possibility of what had before appeared hopeless - namely, the prevention of putrefaction in the wound, and consequently the forestalling of suppuration. To exclude the oxygen of the air from wounds was impossible, but it might be practicable to protect them from microbes.
The first attempt to realize this idea was made upon compound fractures; and the means first employed was carbolic acid, the remarkable efficacy of which in deodorizing sewage made Lister regard it as a very powerful germicide. It was applied to the wound undiluted, so as to form with the blood a dense crust, the surface of which was painted daily with the acid till all danger had passed. The results, after a first failure, were in the highest degree satisfactory, so that, as Lister said in his presidential address to the British Association in Liverpool, he "had the joy of seeing these formidable injuries follow the same safe and tranquil course as simple fractures." The caustic property of undiluted carbolic acid, though insignificant in comparison with the far greater evils to be avoided in compound fracture, made it unsuited for general surgery. To make it applicable to the treatment of abscesses and incised wounds, it was necessary to mitigate its action by blending it with some inert body; and the endeavour to find the best medium for this purpose, such as to combine perfect antiseptic efficiency with the least possible irritation of the tissues, formed the subject of experiments continued for many years in the laboratory and in the ward. At one stage in these inquiries an attempt was made to provide an atmosphere free from living organisms by means of a fine spray of a watery solution of carbolic acid; for it was then supposed by Lister to be necessary not only to purify the surgeon's hands and instruments and the skin of the patient about the seat of operation, but also to wage war with the microbes which, as Pasteur had shown, people every cubic inch of the air of an inhabited room. Under the use of the spray better results were obtained than ever before, and this success encouraged its use. But researches carried on for several years into the relations of the blood to micro-organisms led Lister to doubt the harmfulness of the atmospheric dust. At the London Congress in 1881 he narrated experiments which proved that the serum of the blood is a very unfavourable soil for the development of the bacteria diffused through the air, and others which showed that the cells of an organizing blood-clot have a very remarkable power of disposing of microbes and of limiting their advance. Hence he considered it probable that in surgical operations the atmosphere might be disregarded altogether.' As long, however, as this was only a matter of probability, he did not dare to discard the spray. But at length, at the Berlin Congress in 1890, he was able to announce that the certainty he had so long desired had been arrived at. A careful consideration of the physical 1 See Trans. of the International Medical Congress (1881), vol. ii. P. 373.
constitution of the spray had shown him that the microbes of the dust involved in its vortex could not possibly have their vitality destroyed or even impaired by it. Such being the case, the uniform success obtained when he had trusted the spray implicitly as an aseptic atmosphere, abandoning completely certain other precautions which he had before deemed essential, proved conclusively to his mind that the air might safely be left entirely out of consideration in operating.' Thus he learnt that not the spray only, but all antiseptic irrigations or washings of the wound also, with their attendant irritation of the cut surfaces, might be dispensed with - a great simplification, indirectly due to experiments with the spray. The spray had also served a very useful purpose by maintaining a pure condition of the entourage of the operation; not indeed in the way for which it was devised, but as a very mild form of irrigation. And Lister took care to emphasize the necessity for redoubled vigilance on the part of the surgeon and his assistants when this "unconscious caretaker," as he called it, had been discarded.
The announcement that he had given up the spray was absurdly interpreted in some quarters to mean that he had virtually abandoned his theory and his antiseptic methods. The truth is that the spray was only one of many devices tried for a while in the course of the long-continued endeavour to apply the antiseptic principle to the best advantage, and abandoned in favour of something better. Two main objects were always kept steadily in view by him - during the operation to guard the wound against septic microbes by such means as existing knowledge indicated, and afterwards to protect it against their introduction, avoiding at the same time all needless irritation of the tissues by the antiseptic. Upon the technical methods of attaining these ends this is not the place to enlarge; suffice it to say that the endowments and the industry of the discoverer, as seen in the rapidity and flexibility of mind with which he seized upon and selected the best means, were little less remarkable than the activity of the same faculties in his original ideas.
To illustrate this opinion, his work on the ligature may be taken. It had long been the universal practice of surgeons to employ threads of silk or flax for tying arteries, long ends being left to provide escape of the pus (invariably formed during the tedious process of the separation of the ligature) together with the portion of the arterial coats included in the knot. Lister hoped that if, by antiseptic means, the thread were deprived of living microbes, it would no longer cause suppuration, but might be left with short cut ends to become embedded permanently among the tissues of the wound, which thus would be allowed to heal by primary union throughout. A trial of this method upon the carotid artery of a horse having proved perfectly successful, he applied it in a case of aneurysm in the human subject; and here again the immediate results were all that could be desired. But a year later, the patient having died from other causes, the necropsy showed remnants of the silk thread incompletely absorbed, with appearances around them which seemed to indicate that they had been acting as causes of disturbance. Thus was suggested to him the idea of employing for the ligature some material susceptible of more speedy absorption; and the antiseptic treatment of contused wounds having shown that dead tissue, if protected from putrefaction, is removed by the surrounding structures without the intervention of suppuration, he resolved to try a thread of some such nature. Catgut, which is prepared from one of the constituents of the small intestine of the sheep, after steeping in a solution of carbolic acid, was used in a preliminary trial upon the carotid artery of a calf. The animal was killed a month later, when, on dissection, a very beautiful result was disclosed. The catgut, though removed, had not been simply absorbed; pari passu with its gradual removal, fibrous tissue of new formation had been laid down, so that in place of the dead catgut was seen a living ligature embracing the artery and incorporated with it. The wound meanwhile had healed without a trace of suppuration. This success appeared to justify the use of the catgut ligature in the See Verhandlungen des X internationalen Congresses, Bd. i. p. 33.
human subject, and for a while the results were entirely satisfactory. But though this was the case with the old samples of catgut first employed, which, as Lister was afterwards led to believe, had been "seasoned" by long keeping, it was found that when catgut was used fresh as it comes from the makers, it was unsuited in various ways for surgical purposes. The attempt by special preparation to obtain an article in all respects trustworthy engaged his attention from time to time for years afterwards. To quote the words of Sir Hector Cameron, who was for several years assistant to Lord Lister, it required "labour and toilsome investigation and experiment of which few can have any adequate idea." In 1869 Lister succeeded his father-in-law, Syme, in the chair of clinical surgery of Edinburgh. In 1877 he accepted an invitation to the chair of surgery at King's College, London, in the anticipation that here he would be more centrally placed for communication with the surgical world at home and abroad, and might thus exercise his beneficent mission to more immediate advantage. In 1896 Lister retired from practice, but not from scientific study. From 1895 to 1900 he was President of the Royal Society. In 1883 he was created a baronet, and in 1897 he was raised to the peerage as Baron Lister of Lyme Regis. Among the Coronation honours in 1902, he was nominated an original member of the new Order of Merit.
In England Lister's teaching was slow in making its way. The leading surgeons of Germany were among the first to seize upon the new idea with avidity and practical success; so early as 1875, in the course of a tour he made on the Continent, great festivals were held in his honour in Munich and Leipzig. The countrymen of Pasteur did not lag far behind; and it is no exaggeration to speak of Lister's appearances in foreign countries at this time as triumphal.
The relation of Semmelweiss to Lister is of historical importance. Lister's work on the antiseptic system began in 1864; his first publication on the subject was in March 1867. At this date, and for long afterwards, Semmelweiss was unknown, or ignored, not only by French and Germans, but also by his own Hungarian people; and this neglect broke his heart. The French Academy pronounced against his opinions, and so did the highest pathological authority in Germany. In England, till long after his death, probably his name was not so much as mentioned. In the early 'seventies Lister's method was in full operation in Hungary as elsewhere, yet none of the surgeons of Budapest ever mentioned Semmelweiss; not even when, in 1883, they gave a great banquet to Lister. It was after this occasion that Dr Duka, a Hungarian physician practising in London, wrote a biography of Semmelweiss, which he sent to Lister, and thus brought Semmelweiss before him for the first time. Thenceforth Lister generously regarded Semmelweiss as in some measure his forerunner; though Semmelweiss was not aware of the microbic origin of septic poisons, nor were his methods, magnificent as was their success in lying-in hospitals, suitable for surgical work.
In public Lord Lister's speeches were simple, clear and graceful, avoiding rhetorical display, earnest for the truth, jealous for his science and art, forgetful of himself. His writings, in like manner plain, lucid and forcible, scarcely betray the labour and thought of their production. With the courtesy and serenity of his carriage he combined a passionate humanity, so often characteristic of those who come of the Society of Friends, and a simple love of truth which showed itself in his generous encouragement of younger workers. (T. C. A.)
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Chisholm, Hugh, General Editor. Entry for 'Joseph Lister Lister'. 1911 Encyclopedia Britanica. https://www.studylight.org/encyclopedias/eng/bri/j/joseph-lister-lister.html. 1910.
