Dictionary of National Biography, 1927 supplement/Lister, Joseph
LISTER, JOSEPH, first Baron Lister, of Lyme Regis, (1827–1912), founder of antiseptic surgery, the second son and fourth child of Joseph Jackson Lister, F.R.S., wine-merchant and microscopist [q.v.], was born at Upton House, Upton, Essex, 5 April 1827. His ancestors were members of the Society of Friends since the early part of the eighteenth century. He was educated at Grove House School, Tottenham, and at University College, London, which he entered in 1844. At school he was forward for his age and early showed his taste for natural history by collecting and preparing specimens of various kinds. In later life he frequently spoke of the great influence on him of his father (of whom he has written an account in this Dictionary), and how much he was indebted to him for directing his mind to scientific pursuits and especially to the study of natural history. Whilst still at school, he determined to be a surgeon. None of his near relations were in the medical profession, and it would seem that this desire was entirely spontaneous. He took the B.A. degree of the university of London in 1847, but, owing to an attack of smallpox, he did not begin his medical studies until the autumn of 1848, and was thus rather older than most of his fellow-students. While a student in the faculty of arts, he was present at the first operation under ether in this country—performed by Robert Liston [q.v.] in the theatre of University College Hospital in December 1846.
University College was a small medical school at this time, since it had only been founded in 1828; nevertheless its staff included several men of distinction, and Lister was especially influenced at an early stage of his career by two of these, Wharton Jones and William Sharpey [q.v.]. The former was professor of ophthalmic medicine and surgery, and the latter the celebrated professor of physiology who did so much to lay the foundations on which the modern school of British physiology was raised. Thomas Graham [q.v.], professor of chemistry at University College, was also one of Lister's teachers. Wharton Jones had conducted researches of far-reaching range in physiology, and it must have been largely owing to his influence that Lister's earliest researches were physiological and dealt with the structure and function of tissues. Sharpey had, if anything, an even greater influence, since he not only directed Lister's early physiological inquiries, but advised him, towards the end of his career at University College, to widen his experience by attending the practice of the celebrated Edinburgh surgeon, James Syme [q.v.]; this advice had the most profound influence in moulding Lister's life and career.
During his student career Lister served as house-physician to Dr. Walter Hayle Walshe [q.v.] and as house-surgeon to (Sir) John Eric Erichsen [q.v.], a well-known and capable surgeon but not specially distinguished for any original contributions to the advance of surgery. In 1852 he took his M.B. degree, and at once commenced original work with success. His first work was on the structure of the iris, and he confirmed and extended the demonstration of R. A. von Kölliker that this structure was muscular. This paper and another on the involuntary muscular fibres of the skin were published in 1853 in the Quarterly Journal of Microscopical Science. In this year he also carried on experimental work on the flow of chyle, and during the years 1853–1858 he published a series of papers dealing with physiological problems. One of the most important, on The Cutaneous Pigmentary System of the Frog, dealt with physiological questions of wide range and advanced considerations that have been only quite recently confirmed. Another paper of great importance, The Early Stages of Inflammation, published by the Royal Society in 1857, was the result of one of the most valuable researches that Lister carried out, and the main conclusions which he then formulated have not been controverted with the lapse of time.
On the completion of his career at University College, and armed with an introduction from Sharpey to Syme, Lister went to Edinburgh in September 1853. Syme was at this time fifty-four years of age, a surgeon of acknowledged eminence with much originality, and at the same time a bold and skilful operator and an inspiring teacher. He was a man of decided views, who rather enjoyed controversy but did not brook opposition. Lister, who at first attended Syme's practice as a visitor, soon became a dresser in order to familiarize himself with Syme's methods, and subsequently acted as his house-surgeon for one year. He then decided to settle in Edinburgh, and in 1856 became assistant surgeon to the Royal Infirmary and took an active part in teaching in the extra-mural school, while continuing his researches on inflammation. In 1860 he was appointed to the chair of surgery in Glasgow University, and a year later became surgeon to the Glasgow Infirmary. From this time onward his studies were mainly concerned with suppuration and the treatment of injuries and wounds, and it was during the next few years that he made the observations and discoveries which revolutionized the treatment of disease and injuries.
The wards allotted to him at Glasgow greatly enlarged Lister's clinical experience, but they ‘were particularly insanitary, and all forms of septic diseases of wounds were constantly present in them’. He was greatly distressed by the mortality which followed upon injuries and operations, and gave much thought to the subject. He felt that the solution of the problem would only be arrived at by the study of inflammation and suppuration; hence these questions played a large part in his instruction and in his research work. In 1867 he clearly summarized his views in the following words: ‘In the course of an extended investigation into the nature of inflammation and the healthy and morbid conditions of the blood in relation to it, I arrived several years ago at the conclusion that the essential cause of suppuration in wounds is decomposition brought about by the influence of the atmosphere upon blood or serum retained within them, and in the case of contused wounds upon portions of tissue destroyed by the violence of the injury.’ At the same time Lister became aware that the causative agent was not the air itself, nor indeed any of its gases, since in some injuries where the skin is not broken, as for example, simple fracture of the ribs with injury to the lung, air might be present in the tissues and in contact with effused blood, without any inflammation or suppuration taking place. Lister was unable to afford any full explanation of the facts until his attention was directed in 1865 by his colleague, Dr. Thomas Anderson, professor of chemistry in the university, to the researches of Louis Pasteur, who had proved that putrefaction, like fermentation, was dependent upon the presence in the air of living germs, or vibrios as they were called at first. Lister saw at once the explanation that he had been seeking. Again to quote his own words: ‘When it had been shown by the researches of Pasteur that the septic property of the atmosphere depended, not on the oxygen or any gaseous constituent, but on minute organisms suspended in it, which owed their energy to their vitality, it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles.’ Three methods are available for depriving the air of its germs: filtration, heat, and chemical agents; Lister selected the third as the one most obviously practicable. Prior to becoming acquainted with Pasteur's work, he had practised various methods to secure cleanliness in the routine treatment of wounds, but with no great success. So soon as he determined, in the light of Pasteur's work, to attempt to destroy germs in contact with the wound, by means of a chemical agent, he selected carbolic acid for this purpose. This choice was due to his knowledge of the striking results that had been obtained at Carlisle in the treatment of sewage by this substance when used as a disinfectant. Lister's first attempts were made in the treatment of serious injuries, such as compound fractures. This class of case was at that date a peculiarly serious one, with a very high mortality due to septic infection. Lister, from an early stage of his work, realized that the causes or agents of putrefaction might be present in the injured part before the surgeon intervened, as in the case of a compound fracture, or that they might be introduced at the time of operation, as when an incision is made through unbroken skin. The successful treatment of the former class of case is necessarily much more difficult, and it is striking that he should have selected cases of compound fracture for his first attempts in the new treatment. He first used carbolic acid in the treatment of a compound fracture in March 1865; and in the following spring treated a very severe case of compound fracture in the leg with such complete success that the case practically followed the usual course seen in instances of simple fracture, i.e. there was no general illness and no suppuration. This case formed the basis of his paper in the Lancet, 1867, describing the new method of treatment of compound fracture.
Lister, in his earliest cases, used liquefied German creosote, an impure carbolic acid; this he introduced into the wound and then covered the part with a layer of lint soaked in carbolic acid. After the success obtained in the treatment of compound fractures, he used a similar method in the treatment of abscess. From this time onward he constantly extended the scope of his method and the field of his operations; but he devoted himself more especially to improving the method itself, so as to avoid the irritation produced by the crude carbolic acid. Thus he introduced carbolic oil and carbolized putty, and later he employed carbolized shellac and watery solutions of carbolic acid. From the first he insisted on the necessity of disinfecting instruments and everything else that came in contact with the wound, and he also carried out a thorough disinfection of the patient's skin in the vicinity of the wound. Further, he devoted much time and thought to devising suitable dressings, such as the well-known gauze impregnated with resin and paraffin and then dipped in a watery solution of carbolic acid. He also introduced the carbolic spray apparatus for disinfecting the air in the field of the operation, being at that time impressed with the belief that the air was a most important factor in the causation of sepsis, owing to the presence of germs in its dust. Later, the spray was dispensed with, as it was recognized that the air did not play such an important part as infection derived from the skin, instruments, dressings, &c. Nevertheless the introduction of the spray showed the extreme care which he took in devising all possible means to prevent contamination of the wound.
Lister also greatly improved the technique of operations by inventing new methods of treatment, which likewise had a profound influence in preventing septic infection. Thus he introduced the use of absorbable ligatures and of drainage tubes in the treatment of wounds. Surgeons hitherto had been in the habit of arresting haemorrhage by tying the divided vessels with either hemp or silk; these ligatures had to be cut long and left hanging out of the wound to be separated at a later date, usually about the tenth day after the operation. The separation was necessarily accompanied by ulceration and suppuration, and what is termed secondary haemorrhage was a frequent and much dreaded complication. Lister studied experimentally in animals the changes undergone by ligatures in aseptic wounds, and as a result of these studies, introduced catgut as a suitable substance for ligatures, as it was ultimately absorbed. The raw catgut was, however, unsuitable, and he devoted many years to experiments on catgut, in order to prepare it in such a manner that it should retain its firmness and at the same time be aseptic. His work on ligatures is a striking example of the successful use in surgery of knowledge obtained by preliminary experiments on animals. He also introduced many other improvements in technique, such as the simple expedient of elevating a limb prior to an operation on it, and so rendering it bloodless before the application of a tourniquet, and saving the patient an unnecessary loss of blood.
As a result of his main discoveries, all made in the course of a very few years, the practice of surgery underwent a complete revolution. In Lister's wards septic diseases did not occur, post-operative pyaemia, hospital gangrene, and tetanus disappeared, and erysipelas was rare, unless introduced. Occasionally wounds did not heal without suppuration, but even this was exceptional, and whenever it occurred, all the factors in the case were carefully investigated to ascertain the cause of the failure. Very soon his methods were applied to all kinds of surgical operations. The vanishing of septic diseases enlarged enormously the field of surgery, since operations formerly dreaded, owing to this risk, could now be carried out in safety. Lister himself introduced many new operations for the treatment of diseases and disabilities, that would have been quite impracticable without the assurance that the operation wound would heal with no septic complications. The modern development of surgery in relation to disease and injury of deep-seated organs in the chest, abdomen, &c., was only possible as the result of his discoveries, and it is probable that no man's work has had a greater influence on the progress of surgery; the saving of human life and suffering that he effected is incalculable.
Lister's work as a practical surgeon is sometimes apt to be overlooked owing to the magnitude of his work as a scientific investigator. He devised many new operations in various departments of surgery that would have made the reputation of a lesser man. Throughout his life he was improving his methods and especially the materials employed to render dressings antiseptic. During the last twenty years further modifications have been introduced, and the surgeon now uses heat more and chemical agents less, for the sterilization of instruments and dressings. Modern surgical technique is often termed aseptic rather than antiseptic; this, however, is not a modification of principle but only of method. The principles are the same as those inculcated by Lister, who might, had he liked, have used the term aseptic instead of antiseptic to describe his original method. Lister's methods did not meet with ready acceptance by the surgeons of this country. His own pupils adopted his system with enthusiasm, but the older surgeons were very slow in accepting it. Abroad it met with earlier and greater recognition, especially in France and Germany.
During his tenure of the chair of surgery at Glasgow, Lister was an unsuccessful candidate for the chair of surgery at Edinburgh in 1864, and for a similar chair at his old school, University College, London, in 1866. But in 1869 he became professor of clinical surgery at Edinburgh and remained there until he was invited to King's College, London, in 1877. On accepting this invitation he made the condition that he should bring with him his house-surgeon, (Sir) W. Watson Cheyne, a senior assistant (John Stewart), and two dressers (W. M. Dobie and James Altham), in order that his new methods might be carried out efficiently. Lister filled the chair of clinical surgery at King's College for fifteen years, and during the whole of this time was actively engaged in teaching and in pursuing his researches, besides practising as a surgeon and doing much public work. Thus he played an important part in securing modifications in certain proposed enactments restricting experiments on living animals. He was firmly convinced of the necessity of such experiments for the progress of medicine and surgery, and much of his own work was of this nature. He took an active part in founding (1891) the British Institute of Preventive Medicine on the lines of the Pasteur Institute in Paris, and became its first chairman. In 1897 its name was changed to the Jenner Institute and again in 1903 to the Lister Institute of Preventive Medicine. He was elected a fellow of the Royal Society in 1860 and was its president from 1895 to 1900. He was president of the British Association in 1896. In 1880 he was elected on the council of the Royal College of Surgeons and served for the usual period of eight years; he was unwilling to serve for a further period and thus was never president. In 1883 a baronetcy was conferred on him, and in 1897 he was raised to the peerage as Baron Lister, of Lyme Regis. In 1902 he was one of the twelve original members of the newly constituted order of merit. On the occasion of his eightieth birthday in 1907 he received the freedom of the city of London.
Lister married in 1856 Agnes, the eldest daughter of James Syme, the Edinburgh surgeon. She died in 1903. Throughout their married life she took a great part in assisting him in much of his work, the note-books of his experiments being largely written by her. They had no children. In 1908 Lister left 12 Park Crescent, Portland Place, where he had lived ever since he came to London in 1877, and went to Walmer, where he died 10 February 1912. Burial in Westminster Abbey was offered, but he had left instructions to be buried by the side of his wife. The funeral service was held in Westminster Abbey 16 February 1912, and the burial took place at the West Hampstead cemetery.
There are many portraits of Lister. A presentation portrait painted by John Henry Lorimer in 1896 is in the library hall of the university of Edinburgh. Another portrait, by W. W. Ouless, painted in 1897, is at the Royal College of Surgeons, and a replica is in the library of the Royal College of Surgeons of Edinburgh. He was painted again by Charles E. Ritchie in 1908. A marble bust, executed by Sir Thomas Brock in 1913, is at the Royal College of Surgeons, and a plaster cast of this is in the National Portrait Gallery. In the same gallery is a wax medallion executed by Mrs. Bernard Jenkin in 1898. There are other medallions at University College, London, and at University College Hospital, and one by Brock is in Westminster Abbey. A memorial bust by Brock has been erected in Portland Place, near the house occupied by Lister, 12 Park Crescent. (See Royal Academy Pictures, 1897, 1913.)
[R. J. Godlee, Lord Lister, 1917; Proceedings of the Royal Society, vol. lxxxvi, B, 1912–1913; Lord Lister's Collected Writings, 1909.]