_SIR JOSEPH LISTER AND ANTISEPTIC SURGERY._
Again and again in these pages the hereditary succession of
scientific powers has been illustrated. Not the least eminent example
is to be found in the case of Sir Joseph Lister, who is the son of
Mr. Joseph Jackson Lister, F.R.S., of Upton House, Essex, who in the
words of the Rev. J. B. Reade, F.R.S., in his presidential address
to the Royal Microscopical Society in 1870, “raised the compound
microscope from its primitive and almost useless condition to that
of being the most important instrument ever yet bestowed by art upon
the investigator of nature.” Mr. J. J. Lister was born in London
on January 11, 1786, his parents being members of the Society of
Friends. At fourteen years of age he left school to assist his father
in the wine trade: but though for many years closely occupied in
business, he contrived by early rising and otherwise to supplement
his plain school education, and to make himself accomplished in
mathematics, as well as generally acquainted with most subjects
in literature, science, and art. His predilection for optics was
early shown. As a little child with shortsighted eyes, he enjoyed
looking through air bubbles in the window-pane, enabling him to see
distant objects more clearly. At school he was the only boy who
possessed a telescope. He soon became addicted to microscopical
study; but it was not till 1824, when he was 38 years old, that he
thought of improving the object-glass of the compound microscope,
and made suggestions to W. Tulley, the optician, which resulted in
the production of a new object-glass much less thick and clumsy,
which speedily became the favourite. On January 21st, 1830, he read
a paper before the Royal Society “On the Improvement of Compound
Microscopes,” announcing the remarkable discovery of the existence of
two aplanatic foci in a double achromatic object-glass. This formed
a basis for subsequent important improvements. In 1837 he gave to
Andrew Ross the construction for a ⅛-inch objective of three compound
lenses, by which that maker’s fame was largely increased, and it
became the standard form for high power for many years. He also made
some notable researches “On the Structure and Functions of Tubular
Polypi and Ascidiæ” (Phil. Trans. 1834), and independently came to
the same conclusions as Sir George Airy, the late Astronomer-Royal,
on the limits of human vision as determined by the nature of light
and of the eye; but his paper on this subject was never published,
owing to the publication of Sir George Airy’s researches. He survived
in vigorous health to see his son Joseph in secure possession of
fame, dying on October 24, 1869. His son records[12] that “he was
most unselfish, and scrupulously tender of hurting the feelings of
others, and extremely generous in the pecuniary support of public
philanthropic objects, as well as in secret acts of charity. Though
warmly attached to the religious Society of Friends, to which he
belonged, he was a man of very liberal views and catholic sympathies.
But the crowning grace of this beautiful character, though it might
veil his rich gifts from those not intimate with him, was a most rare
modesty and Christian humility.”
JOSEPH LISTER was born in 1828, and took the B.A. degree at
London University in 1847. Pursuing a course of medical study at
University College, London, he gained the M.B. degree in 1852, being
awarded gold medals in anatomy and in botany at the first M.B.
examination, and the scholarship and gold medal in surgery at the
final examination. He became Fellow of the Royal College of Surgeons
in 1852, and took a similar qualification at Edinburgh in 1855. He
married a daughter of Mr. Syme, then Professor of Surgery in the
University of Edinburgh.
Devoting himself to physiological research on matters having a wide
bearing on practical medicine and surgery, Mr. Lister attained wide
repute as an original investigator at a comparatively early age, and
his position in physiology was assured by a series of papers which
would suffice to make his career memorable, if he had never applied
antiseptic measures to the treatment of disease. Beginning with some
observations on the contractile tissue of the iris in 1853, he went
on to study the muscular tissue of the skin, the flow of the lacteal
fluid, and the minute structure of involuntary muscular fibre, on
all of which subjects his papers are published in the “Journal
of Microscopical Science.” In 1857 he commenced his series of
contributions to the Royal Society, the first being on the functions
of the visceral nerves, with special reference to the inhibitory
system. This was further developed in “An Inquiry regarding the
Parts of the Nervous System which regulate the Contractions of the
Arteries” (Phil. Trans. 1858). But his two most important papers at
this period are those on the Early Stages of Inflammation (1857), and
on the Coagulation of the Blood, delivered as the Croonian Lecture
for 1863.
For some years Mr. Lister was a lecturer on surgery in the Edinburgh
Extra-Academical School. He was afterwards elected Professor of
Surgery in Glasgow University, and Surgeon to the Glasgow Royal
Infirmary.
While Mr. Lister held these appointments, circumstances occurred
which were calculated to stimulate to the highest degree the effort
to discover some method of dressing wounds which should obviate the
dangers of putrefactive changes. About 1860 a new surgical hospital
was erected as part of this infirmary, and although many of the
most approved principles of hospital construction had been adopted,
the building proved extremely unhealthy. Pyæmia, erysipelas, and
hospital gangrene soon showed themselves, affecting on the average
most severely those parts of the building nearest to the ground. For
several years Mr. Lister found that in his male accident ward, which
was on the ground-floor, when nearly all the beds contained patients
with open sores, the diseases which result from hospital atmosphere
were sure to be present in an aggravated form; whereas, when a large
proportion of the cases had no external wound, these evils were
greatly mitigated or entirely absent. At this period the managers
were very desirous of introducing additional beds into the wards,
to supply accommodation for the rapidly increasing population of
Glasgow; and Mr. Lister strongly and firmly resisted such increase in
his wards. Some of the wards indeed at times became subject to such
severe mortality that they had to be closed for various periods. One
particular visitation was so serious that it was resolved to make an
investigation to discover if possible the cause of the evil, which
might, one would think, have been done at an earlier period. Great
was the shock of every one concerned to find that a few inches below
the surface of the ground behind the two lowest male accident wards,
with only the basement area, four feet wide, intervening, there was
the uppermost tier of a multitude of coffins, which had been placed
there at the time of the cholera epidemic of 1849. The corpses had
undergone so little change in the interval that the clothes they had
on at the time of their hurried burial were plainly distinguishable.
The wonder was, not that these wards on the ground-floor had been
unhealthy, but that they had not been absolutely pestilential. Yet
at the very time when this shocking disclosure was made, Mr. Lister
was able to state, in an address which he delivered to the British
Medical Association at Dublin in 1867, that during the previous nine
months, in which his new antiseptic plans of treatment had been in
operation in his wards, not a single case of pyæmia, erysipelas, or
hospital gangrene had occurred in them.
The managers of the infirmary of course did all in their power
to remedy this insalubrious state of things. They poured large
quantities of carbolic acid and quicklime upon the ground,
considering this a less dangerous proceeding than to attempt the
removal of the putrefying mass; they covered the ground with an
additional thickness of earth, and adopted other measures. The
hospital itself was far from being well situated in other respects.
It abutted against the old Cathedral Churchyard, much used for the
“pit burial” of paupers in a most deleterious state of aggregation.
Yet during the two years and a quarter intervening between the Dublin
address and Mr. Lister’s leaving Glasgow for Edinburgh, his new
antiseptic system continued in the main as successful as before.
In the course of the year 1864 Professor Lister had been much struck
with an account of the remarkable effects produced by carbolic
acid upon the sewage of the town of Carlisle, the admixture of a
very small proportion not only preventing all odour from the lands
irrigated with the refuse material, but also destroying the entozoa
which usually infest cattle fed upon such pastures. His attention
having been for several years greatly directed, as we have seen
above, to the subject of suppuration, especially in its relation to
decomposition, he saw that such a powerful antiseptic was peculiarly
adapted for experiments with a view to elucidating that subject, and
thus the applicability of carbolic acid to the treatment of compound
fractures occurred to him.
The antiseptic system was put into practice in the Glasgow Infirmary
in March 1865, but at first applied almost exclusively in compound
fractures (or those in which there is an external wound) and
abscesses. From 1867 it was employed for almost all surgical cases.
It arose out of Mr. Lister’s study of Schwann and Pasteur’s germ
theory and the experiments connected with them. He repeated many of
the experiments, and devised new methods calculated to test whether
they were capable of explaining the phenomena of putrefaction. These
sufficed to prove definitely that in putrefaction the development of
such organisms as the microscope could detect, and the concomitant
putrefactive changes, were occasioned by minute germs suspended in
the atmosphere. Professor Tyndall’s beautiful experiments, by which
he demonstrated the perfect manner in which cotton wool filters the
air of its suspended particles, led to the idea (suggested by Dr.
Meredith of the Indian service to Mr. Lister) that cotton wool might
be used with advantage as an antiseptic dressing. The cotton wool
must itself be rendered pure of germs by some antiseptic agency, for
by the theory the air within it must contain germs. But the main
feature upon which Mr. Lister for a long time relied was the copious
use of carbolic acid in such a form as to prevent the occurrence of
putrefaction in the part concerned.
Mr. Lister’s first paper on the subject, published in the _Lancet_
for 1867, struck a chord which the editor of that journal emphasised
as follows on August 24 of that year (p. 234): “If Professor Lister’s
conclusions with regard to the power of carbolic acid in compound
fractures should be confirmed by further experiment and observation,
it will be difficult to overrate the importance of what we may
really call his discovery. For although he bases his surgical use
of carbolic acid upon the researches of M. Pasteur, the application
of these researches to the case of compound fractures, opened
abscesses, and other recent wounds, is all his own.” The risk of
blood-poisoning after operations in themselves slight, was declared
to be the one great opprobrium of surgery. There was no limit to
the operative skill of surgeons, but a miserable and serious risk of
fatal after-consequences against which the surgeon had no defence.
Mr. (now Sir James) Paget had in 1862 given forth an idea of which
we can now more clearly see the bearing, when he said that the best
results he had seen in cases of pyæmia were with patients kept night
and day in a current of wind. We now see that this in fact amounted
to continually passing over the patient air less charged with germs
than that of the room or ward in which he was placed. Mr. Lister
contemplated the destruction of these germs at the seat of the wound,
and the prevention of the access of fresh germs.
An example will perhaps illustrate the matter better than a
theoretical account. An experiment was performed on the 31st December
1868 on a young calf a few days old, under chloroform, namely, the
tying of the carotid artery on the antiseptic system, with threads
composed of animal tissue. The threads employed had all been soaked
for four hours in a saturated watery solution of carbolic acid, which
swelled and softened them. The hair near the wound was cut short,
and a solution of carbolic acid in linseed oil rubbed well into the
skin to destroy any putrefactive organisms lying amongst the roots
of the hair. The sponges employed in the operation were wrung out of
a watery solution of the acid, and all the instruments introduced
into the wound, together with the fingers of the operator’s left
hand and the copper wire used for sutures, were treated with the
same lotion, some of which was poured into the wound after the
introduction of the last stitch, at one of the intervals left for
the escape of discharge, to provide against the chance of any fresh
blood which might have oozed out during the process of stitching
having passed back and taken fresh germs in with it. The external
dressing was a towel saturated with the oily solution of carbolic
acid, folded as broad as the length of the neck, wrapped so as to
extend freely beyond the wound, and prevented by several contrivances
from slipping. A sheet of gutta-percha tissue was applied outside to
prevent contamination of the antiseptic towel from without. A few
ounces of the oily solution were poured daily over the towel for the
first week, after which the dressings were left untouched for three
days and then entirely removed. The wound was found quite dry, and
free from tenderness. When the animal was subsequently killed, the
ligatures were seen to be converted into living tissue; and such
experiments proved how valuable animal fibres might be as ligatures
under the antiseptic system.
Again, a portion of cotton wool was impregnated with about one
two-hundredth part of its weight of carbolic-acid vapour, and the
surface of a granulating sore and surrounding skin was washed with
a dilute solution of the acid. A piece of oiled silk of the size of
the sore was then applied, to prevent the dressings from sticking
through becoming dry. Over this was placed a piece of folded linen
rag of rather larger size, and similarly impregnated with carbolic
acid vapour to the cotton wool; this being intended to absorb any
discharge from the sore. Lastly, an overlapping mass of carbolised
cotton wool was securely fixed over all. The result was that although
all chemical antiseptic virtue left the dressing by evaporation of
the volatile carbolic acid in a day or two, yet putrefaction was
practically excluded by the cotton wool for any length of time.
Subsequently another variety of protective material was adopted,
namely antiseptic gauze, a loose cotton fabric, the fibres of which
were impregnated with carbolic acid lodged in insoluble resin. The
interstices between the fibres were kept free from these ingredients,
so that the porous fabric might readily absorb discharges. By
arranging this in a sufficient number of layers and covering the
whole with a layer of mackintosh, the discharge was compelled to
pass through the whole length of the antiseptic dressing. Thus it
was almost certain that if no putrefactive mischief were left in a
wound or abscess, none would enter it, however profuse might be the
discharge.
If a wound was presented for treatment, inflicted by some other
than the surgeon, some dust was sure to have been introduced, which
probably contained putrefactive germs. The energy of these had
first to be destroyed by washing the raw surface with some strong
antiseptic agent. But in operating upon a previously unbroken skin,
Mr. Lister considered that he could prevent the septic particles
from entering at all, by operating in an antiseptic atmosphere. This
was provided by producing a shower of spray of carbolic acid of the
finest character. This answered exceedingly well when the solution
producing the spray consisted only of one part of carbolic acid to
100 parts of water.
Here we must limit our detailed account of the antiseptic system.
Under it large abscesses are opened, the matter pressed out, and
fresh matter does not form, and cures are effected in severe cases
which scarcely ever used to be cured. Arteries are tied with a
security before unknown. Amputations and excisions are effected with
a safety and diminished mortality quite surprising. Even senile
gangrene shows hopeful results which were previously quite out
of question. Pyæmia, hospital gangrene, and erysipelas have been
almost banished from wards where the system is properly carried
out. Recently a modification has been introduced, in which there
is employed, not a volatile material as in the case of carbolic
acid, but a dilute solution of corrosive sublimate combined with
albumen. Gauze is now prepared for Sir Joseph Lister steeped in
this substance, and it may become generally adopted; but it does
not appear likely to supersede carbolic acid for the purification
of instruments, sponges, the skin, or as a substitute for the
carbolic spray. The particular form of antiseptic is a matter of
detail, on which improvement may long continue to be made; but
the development of the essential idea of preventing the access of
germs which can cause putrefactive changes by one method or another,
and the destruction of them as far as possible when they have
obtained access, will remain connected with Sir Joseph Lister as
an achievement of the highest force; indeed his name seems likely
to give a new word to our language, namely Listerism, by which the
essential features of his system are understood.
Professor Lister was awarded a Royal Medal by the Royal Society of
London in 1880, having previously received the high distinction of
the MacDougall Brisbane Prize from the Royal Society of Edinburgh
in 1875, for a remarkable paper on the Germ Theory of Fermentative
Changes. He was created a baronet in December 1883. The universities
of Cambridge, Edinburgh, and Glasgow had conferred upon him the
honorary degree of LL.D., and Oxford that of D.C.L. He has been for
some years Surgeon to King’s College Hospital, having succeeded Sir
William Fergusson.
FOOTNOTES:
[12] _Monthly Microscopical Journal_, 1870, iii. p. 143.