Popular Science Monthly/Volume 52/March 1898/Sketch of Sir Joseph Lister
JOSEPH LISTER.
| SKETCH OF SIR JOSEPH LISTER. |
THE merits of Lord Lister's work in the institution of antiseptic and aseptic surgery are recognized as of the very highest value to the human race, and all nations are delighted to do him honor for it. The general feeling is summarized in an English chronicle which says that for it "he is justly regarded as one of the world's greatest benefactors." Prof. H. Tillmanns, in an estimate of him published in Nature's "Scientific Worthies," speaks of it as his "immortal lifework," and as constituting "the greatest advance which surgery has ever made."
Sir Joseph Lister received by descent the tastes and aptitudes which have enabled him to reach his present eminence. His father, Joseph Jackson Lister, though a man in business, found time to devote to science, was a Fellow of the Royal Society, devised an improvement in the microscope, concerning which he published a paper on achromatic glasses in the Philosophical Transactions; contributed other papers to that publication; and, with Dr. Hodgkin, first described the tendency of the red corpuscles of the blood to arrange themselves in rouleaux.
Joseph Lister was born at Upton in Essex, England, in 1827; was taught at a private school of the Society of Friends in Tottenham; was graduated Bachelor of Arts at the University of London in 1847; and studied medicine at University College, London, where his attention was specially directed to physiology. Having been graduated in medicine from the University of London in 1852, and enjoyed a creditable career at the hospital, he went to Edinburgh, where he became associated with the late Professor Syme, whose daughter he married, and was his house surgeon for a time. He was appointed assistant surgeon to the Royal Infirmary, and extra-academical lecturer on surgery, in which capacities he added to his reputation. In 1860 he was appointed regius professor of surgery in the University of Glasgow. During all this period lie published many papers, the general trend of which seemed to direct itself toward the field on which he has won his supreme fame. His first papers, published in 1853, while he was still a student, were on the muscular tissue of the skin and the contractible tissue of the iris. Of papers published in Edinburgh between 1857 and 1860, those dealing with the subjects of inflammation and the coagulation of the blood are mentioned as having been the most important. The expressions of his views on this last subject were one of the features of his Croonian Lecture of 1862, which, Nature says, "excited great interest, upsetting as it did most of the accepted notions, and forming the groundwork of much of our modern teaching on the subject."
Lister's work in connection with antiseptic surgery began while he was at Glasgow. Some of the surgical wards of the Royal Infirmary there were distinguished for their unhealthiness, in which they were hardly surpassed in the kingdom. The method he employed then was very crude and rudimentary, but he applied it with the result, as he was able to believe he could say without exaggeration, that those particular wards became "the healthiest in the world; while other wards, separated from mine only by a passage a few feet broad, where former modes of treatment were for a while continued, retained their former insalubrity." Equally striking changes were afterward witnessed in other institutions, as in the Allgemeines Krankenhaus in Munich, the director of which, Professor von Nussbaum, sent his assistant to Edinburgh, whither Lister had removed, to learn the details of the antiseptic system as it was then practiced. From the day the system was introduced into the Krankenhaus, hospital gangrene, which had infected eighty per cent of the wounds treated, disappeared entirely, and pyæmia and erysipelas soon followed it. "But it was by no means only in removing the unhealthiness of hospitals that the antiseptic system showed its benefits. Inflammation being suppressed, with attendant pain, fever, and wasting discharge, the sufferings of the patient were, of course, immensely lessened; rapid primary union being now the rule, convalescence was correspondingly curtailed; while as regards safety and the essential nature, it became a matter of indifference whether the wound had clean-cut surfaces which could be closely approximated, or whether the injury inflicted had been such as to cause destruction of tissue. And operations which had been regarded from time immemorial as unjustifiable were adopted with complete safety."
Lister relates in his British Association address that he had been long impressed with the greatness of the evil of putrefaction in surgery, and had done his best to mitigate it by the use of various deodorant lotions. It does not appear to have been quite clear as yet what the cause of it was. Liebig's theory that it was an effect of oxygen was still current; and if this were the fact, the prevention altogether seemed to be hopeless. "But when Pasteur had shown that putrefaction was a fermentation caused by the growth of microbes, and that these could not arise de novo in the decomposable substance, the problem assumed a more hopeful aspect. If the wound could be treated with some substance which, without doing too serious mischief to the human tissues, would kill the microbes already contained in it and prevent the future access of others in the living state, putrefaction might be prevented, however freely the air with its oxygen might enter." He had heard of carbolic acid as having a remarkable deodorizing effect on sewage, and, having obtained a quantity, determined to try it in compound fractures. "Applying it undiluted to the wound, with an arrangement for its occasional renewal, I had the joy of seeing those formidable injuries follow the same safe and tranquil course as simple fractures in which the skin remains unbroken." The earliest antiseptic dressings were very cumbrous. At first an antiseptic crust of blood and pure carbolic acid was formed, and protected by a sheet of block tin; next carbolic acid and oil were used; then a layer of putty made with carbolic acid was applied; after this, a plaster made of shellac and carbolic acid. This was superseded by the typical dressing, or the Lister bandage, in which a layer of waterproof silk, the "protective," was placed over the wound to protect it from the direct action of the irritant substance in the antiseptic dressing materials; over this came some eight or more layers of carbolized gauze or muslin, with a sheet of guttapercha tissue between the outer two of these. The whole was then bound round with carbolized gauze, so as to effect as far as possible an air-tight inclosure of the wound. With this was associated a spraying of carbolic acid when the wound was being treated or the bandages were being applied or changed, in order to prevent the access of microbes in the air. As the structure of the bandage became gradually simpler and more convenient, so the system itself was improved and simplified till, while the principle remains the same, the mode of applying it has become very different from what it was at first. The most important of these improvements seems to have been suggested in 1871 or 1872 by a paper of Dr. Burdon Sanderson's showing that bacteria, unlike the spores of fungi, are deprived of vitality by mere desiccation at an ordinary temperature, so that, while a drop of water from ordinary sources or the contact of a moist surface is sure to lead to bacteric development and putrefaction in an organic substance susceptible of that change, the access of dust from exposure to the atmosphere merely induces the growth of fungi and comparatively insignificant chemical alteration. "If this were true," Lister said, in a communication to the Royal Society of Edinburgh made in April, 1873, "it would be needless to provide an antiseptic atmosphere in carrying out the antiseptic system of treatment; and all that would be requisite in the performance of a surgical operation would be to have the skin of the part about to be operated upon treated once for all with an efficient antiseptic, while the hands of the surgeon and his assistants and also his instruments were similarly purified; a dressing being afterward used to guard against the subsequent access of septic material. Thus the use of the spray might be dispensed with, and no one would rejoice more than myself in getting rid of that complication." The suggestion thus indicated was not acted upon in surgical practice till after much testing and experiment, by which Lister was led to conclude, definitely, that it was the grosser forms of septic mischief, rather than microbes in the attenuated condition in which they exist in the atmosphere, that were to be dreaded in surgical practice. At the London Medical Congress, in 1881, he hinted that it might turn out possible to disregard altogether the atmospheric dust, but he still did not venture as yet to try this upon his patients.
At the Berlin Congress, in 1890, he brought forward what he regarded as absolute demonstration of the harmlessness of the atmospheric dust in surgical operations and of the sufficiency of methods in which irritation of the wound by strong antiseptics was avoided.
Under the method now in use, as described by Prof. H. Tillmanns in Nature's "Scientific Worthies," "operations are performed with almost painfully precise sterilization of every object or instrument employed, as Lister first taught us to do, while at the same time we limit as far as possible the action of irritant antiseptics, such as carbolic acid, and even advantageously use none at all, operating with as little fluid as possible. So far as it may be necessary, the fluid now employed is a sterilized solution of common salt, or else sterilized water. In the place, then, of carrying out our operations under the former strictly antiseptic precautions, we now operate aseptically. But the fundamental idea on which Lister's antiseptic method was based has remained unchanged, and will always be the same. . . . The operational area on the patient is carefully disinfected in accordance with Lister's instructions, and is surrounded with aseptic linen compresses sterilized in steam at from 100° to 130° C. We employ exact and definite methods to free our hands from microbes, and the instruments are sterilized by boiling in one-per-cent solution of sodium carbonate. All bandages and the outer garments we wear are made aseptic by prolonged exposure to steam at from 100° to 130° C, in a specially constructed apparatus; and so, also, in respect to all else. Steam thus provides us nowadays with non-irritant bandaging materials free from germs with even greater certainty than did their earliest impregnation with antiseptic substances. . . . Instead of sponges we now use muslin absorbents sterilized by steam, and these, like every other fragment of bandaging material, are burned after being used but once. In short, the technics of modern surgery is based on Lister's method, and takes for its watchword, 'asepsis without the use of antiseptics.' Antisepsis has given place to asepsis, but the latter is just as surely based on the ground first broken by Lister." The earlier results that followed the application of Lister's methods are described as having been simply astounding, and the feelings they inspired as like those that follow "a mighty victory finally won after prolonged and grievous defeats." In those hospitals where septicæmia had been most certain, the best results were obtained, and wound fevers came to be no longer dreaded. Equally good and certain results attend the treatment carried out under aseptic precautions. Surgery now hardly hesitates at anything, but fearlessly deals with every organ of the human body. Operations that were approached with extreme hesitation, or were put off till the last possible moment, or were not ventured upon at all, are now undertaken fearlessly, and with the certainty that no harm will come in them from putrefaction. "It now celebrates its greatest triumph in dealing with the skull and cranial cavity, with the brain, spinal column and spinal canal, with the thoracic and abdominal viscera, with bones and joints, with tendons and nerves; and patients are not afraid to trust themselves with the surgeons in the most delicate operations, and such as once would have been certainly fatal.
Lister's views were much controverted at first, and it was a long time before they were generally accepted in England. Then, when the application of the system had been modified in the light of additional study and experiment, and it became aseptic instead of antiseptic, they said that he had shifted his ground. This was not so, for the fundamental principle on which it has rested has all been the same, and the differences in application are only of detail; and, as we have already seen, he was almost from the beginning considering whether he could not dispense with the spraying, having deduced the conclusion that it was not indispensable long before he ventured to omit it.
Professor Tillmanns claims that it was in Germany first, rather than in England, that Lister's scientific works met with their earliest recognition and general appreciation; tells how he, like other German surgeons, sought out "the founder of modern surgery" in his London hospital, and, "filled with gratitude," laid his homage at his feet; and gleefully speaks of the ovation which the professors and students offered him a few years ago at Leipsic.
In 1869 Lister was appointed to the chair of clinical surgery in the University of Edinburgh, where he succeeded Dr. Syme, his father-in-law; where large and enthusiastic classes listened to his lectures; whence the reputation of his clinic extended through the world; and where he continued the elaboration of his system, introducing some of the simplifications we have already described. In 1877 he was appointed to suceeed Sir William Ferguson as professor of clinical surgery at King's College, London. He held this position till 1893. In 1876 he was appointed by the Privy Council to the General Medical Council for Scotland.
Lister's later writings, consisting mainly of articles scattered through various periodicals, have been devoted chiefly to subjects connected with the germ theory of disease, and include investigations into the processes of fermentation and the life history of certain micro-organisms, and papers on the bearing of bacteriology upon surgical treatment.
The discovery of the antiseptic system is a matter of such transcendent importance as almost to obscure the many other improvements and modifications which Lister introduced into surgical practice. He devised a way of bloodless amputation by simply elevating the limb, so that an emptying of it was effected both mechanically and by means of a contraction of the arteries consequent upon the altered position. He invented a tourniquet for compressing the abdominal aorta, whereby the hæmorrhage was diminished in operations in the neighborhood of the hip joint. He introduced the amputation called by his name, and an operation for excision of the wrist. He was the first to undertake osteotomy for the purpose of rectifying deformity of the limbs. He advocated a more complete method than had been practiced of operating on cancer of the breast, and introduced the treatment of fractures of the patella and other bones communicating with joints by means of open incisions and wiring.
The medal of the Royal Society was conferred on Dr. Lister in 1880; and in 1881 the prize of the French Academy of Sciences was awarded to him for his observations and discoveries in the application of the antiseptic treatment in surgery. In 1883 he was made a baronet on the recommendation of Mr. Gladstone. In 1896 he was president of the British Association, and in his presidential address gave an extremely modest narrative of his experiments and the development of his aseptic method. He has received numerous honorary degrees and honors from colleges and learned societies. He succeeded Lord Kelvin as president of the Royal Society in 1895; was raised to the peerage as Lord Kinnear in 1897; and is surgeon extraordinary to the Queen.