1851, when Lister completed his studentship and became for a time an
active member of the hospital staff. This year was important as
introducing him to the practice of his art under the direction of
Erichsen, an Anglo-Dane and one of the foremost surgeons in London. It
also led to a change in his way of living, to his being thrown into
closer relations with men of his own age, and to his taking a more
lively part in social gatherings. What we hear of the essays that he
wrote at school, what we can read of his early letters, all harmonizes
with our conception of a Quaker upbringing. There is a staid primness
about him, which contrasts strangely with the pictures of medical
students presented to us in the pages of Dickens. Capable though he was
of enjoying a holiday, or of expanding among congenial associates,
Lister was not quick to make friends. He was apt to keep too much to
himself; and he seems to have inspired respect and even a certain awe
among men of his own age. In his youth men noticed the same grave mien,
steadfast eyes, and lofty intellectual forehead which are conspicuous in
his later portraits. He was steady in conduct, serious in manner,
precise in his way of expressing himself; and while these qualities
helped him in the mental application which was so necessary if he was to
profit by his student days, he needed a little shaking up in order to
adapt himself to the ways of other men in the sphere of active life.
This was given him by the constant activities of the hospital, and by
the demands which the various societies made upon him; but he did not
allow them to interfere with his own researches, for which he could find
time when others were overwhelmed by the routine of their daily tasks.
His first bit of original research is of special interest because it
connects him with his father's work. He made special observations with
the microscope of the muscular tissue of the iris of the eye,
illustrated his paper by delicate drawings of his own, and published it
in the leading microscopical journal. This and a subsequent paper on the
phenomena of 'Goose-skin' attracted some attention among physiologists
at home and abroad, and brought him into friendly relations with a
German professor of world-wide reputation. They also gave great
satisfaction to his father and to his favourite teacher Sharpey.
But Lister's development henceforth was to take place on Scottish
ground, and his visit to Edinburgh in 1853 shaped the whole course of
his career. James Syme, under whose influence he thus came, was the most
original and brilliant surgeon then living in the British Isles, perhaps
in all Europe. His merits as a lecturer were somewhat overshadowed by
his extraordinary skill as an operator; but he was a remarkable man in
all ways, and the fact that Lister was admitted, first to his
lecture-room and operating theatre, and then to his home, was without
doubt the happiest accident in his life.
The atmosphere of Edinburgh with its large enthusiastic classes in the
hospitals, its cultivated and intellectual society outside, supplied
just what was wanted to foster the genius of a young man on the
threshold of his career. In London, centres of culture were too widely
diffused, indifference and apathy too prevalent, conservatism in
principles and methods too strongly entrenched. In his new home in the
north Lister could watch the boldest operator in his own profession, and
could daily meet men scarcely less distinguished in other sciences, and
as a visitor to Syme's house he was from time to time thrown among able
men following widely different lines in life. Above all, here he met one
who was peculiarly qualified to be his helper; and three years later, at
the age of twenty-nine, he was married to Agnes Syme, the daughter of
his chief, to whom he had been attracted, as can be seen from the
letters which passed between Edinburgh and Upton, soon after his arrival
in the north. Before this event, he had already made his mark as
Resident House Surgeon, as assistant operator to Syme, and also as an
independent lecturer under the liberal system which gave an opening to
all who could establish by merit a claim to be heard. He had also begun
those researches into the early stages of inflammation which, ten years
later, were to bear such wonderful fruit. It was a full and busy life,
and the distraction of courtship must have made it impossible for him at
times to meet all demands; but after 1856 his mind was set at rest and
his strength doubled by the sympathy which his wife showed in his work,
and by the help which she was able to render him in writing to his
dictation.
For their honeymoon they took a long journey on the Continent in the
summer of 1856; but half, even of this rare holiday, was given to
science, and, after some weeks' enjoyment of the beauties of Italy,
husband and wife made the tour of German universities, as he was
desirous to see something, if possible, of the leading surgeons and the
newest methods. Vienna, Dresden, Berlin, Munich, Frankfort, Heidelberg,
and Stuttgart were all included in the tour. They were well received,
and at Vienna the most eminent professor of Pathology in the University
gave more than three hours of his time to showing his museum to Lister,
and also invited the young couple to dine at his house. Though he had
not yet made a name for himself, Lister's earnestness and intelligence
always made a favourable impression; and as he had taken pains with
foreign languages in his youth, he was able, now and later in life, to
address French and German friends, and even public meetings, in their
native tongue. He came back to find work waiting for him which would tax
his energies to the full. In October 1856 he was elected Assistant
Surgeon to the Infirmary, and now, in addition to lecturing, he had to
conduct public operations himself, whereas he had hitherto only acted as
Syme's assistant. This was at first a severe trial for his nerves. That
it affected him differently from most experienced surgeons is shown by
the fact that he used always, all his life, to perspire freely when
starting to operate; but he learnt to overcome this nervousness by
concentrating his attention on his work. He was not a man who had
religious phrases on his lips; but in letters to his family, quoted by
Sir Rickman Godlee, he gives us the secret of his confidence and his
power. 'Yesterday', he says in a letter written to his father on
February 26, 'I made my début at the hospital in operating before the
students. I felt very nervous before beginning; but when I had got
fairly to work, this feeling went off entirely, and I performed both
operations with entire comfort.' A week later, in a letter to his
sister, he returns to the subject. 'The theatre was again well filled;
and though I again felt a good deal before the operation, yet I lost all
consciousness of the presence of the spectators during its performance,
and did it exactly as if no one had been looking on. Just before the
operation began I recollected that there was only one Spectator whom it
was important to consider, one present alike in the operating theatre
and in the private room; and this consideration gave me increased
firmness.' Interest in the work for its own sake, forgetfulness of
himself, these were to be the key-notes of his life-work.
As yet, to a superficial observer, there were not many signs of a
brilliant career ahead of him. His private practice was small and did
not grow extensively for many years. The attendance at his earlier
course of lectures was discouragingly meagre. This would have been more
discouraging still, had not his dressers, from personal affection for
him, made a point of attending regularly to swell the number of the
class. Indeed, in view of the exacting demands made on him by the
hospital, Lister might have been content to follow the ordinary routine
of his profession. With his wife at his side and friends close at hand,
he had every chance of living a useful and happy life. But he still
found time to conduct experiments and to think for himself. His
researches were continued along the line which he had opened up in 1855,
and in 1858 he appeared before an Edinburgh Surgical Society to read a
paper on Spontaneous Gangrene.
This gave Mrs. Lister an opportunity to show her value. All his life
Lister was prone to unpunctuality and to being late with preparations
for his addresses, not because he was indifferent to the convenience of
others or careless about the quality of his teaching, but because he
became so engrossed in the work of the moment that he could not tear
himself away from it so long as any improvement seemed possible. This
same quality made him slow over his hospital rounds and often over
operations, with the result that his own meal-times were most irregular
and his assistants often had trouble to stay the pangs of hunger. This
handicapped him in private practice and in some measure as a lecturer.
He gave plenty of thought to his subjects, but rarely began to put
thoughts in writing sufficiently in advance of his engagement. When he
was in time with his written matter the credit was chiefly due to his
wife. On the occasion of this paper she wrote for seven hours one day
and eight hours the next, and her heroic industry saved the situation.
Towards the end of 1859 Lister decided to be a candidate for the
Surgical Professorship at Glasgow, which appointment was in the gift of
the Crown; and in spite of some intrigues to secure the patronage for a
local man, the post was offered by the Home Secretary, Sir George Lewis,
to the young Edinburgh surgeon. Syme's opinion and influence no doubt
counted for much. Lister's appointment dated from January 1860, but it
was not till a year and a half later that his position in Glasgow was
assured by his being elected Surgeon to the Royal Infirmary. Before this
he could preach his principles in the lecture-room, but he had little
influence on the practice of his students and colleagues. Thanks to the
reputation which he brought from Edinburgh, his first lecture drew a
full room, and his class grew year by year till it reached the
unprecedented figure of 182, and each year the enthusiasm seemed to
rise. But in the hospital he had an uphill task, as any one will know
who has studied the history of these institutions in the first half of
the century.
To-day the modern hospital is an object of general admiration, with its
high standard of cleanliness and efficiency; and few of us would have
any hesitation if a doctor advised us to go into hospital for an
operation. Seventy or a hundred years ago the case was very different;
and when we read the statistics of the early nineteenth century,
gathered by the surgeons who had known its horrors, it is hard to
believe that we are not back among the worst abuses of the Middle Ages.
Such terrible scourges as pyaemia and hospital gangrene were rife in all
of them. In the chief hospital of Paris, which for centuries claimed
pre-eminence for its medical faculty, the latter disease raged for 200
years without intermission: 25 per cent. of those entering its doors
were found to have died, and the mortality after certain operations was
more than double this figure. Erichsen, who published in 1874 the
statistics of deaths after operations, quoted 25 per cent. in London as
satisfactory, and referred to the 60 per cent. of Paris as not
surprising. In military practice the number of deaths might reach the
appalling figure of 80 or 90 per cent. What was so tragic about this
situation was that it was precisely hospitals, built to be the safeguard
of the community, which were the most dangerous places in the case of
wounds and amputations. In 1869 Sir James Simpson, the famous discoverer
of chloroform, collected statistics of amputations. He took over 2,000
cases treated in hospitals, and the same number treated outside. In the
former 855 patients (nearly 43 per cent.) died, as it seemed, from the
effects of the operation; in the latter only 266 cases (over 13 per
cent.) ended fatally. He went so far as to condemn altogether the system
of big hospitals; and under his influence a movement began for breaking
them up and substituting a system of small huts, which, whether tending
to security or not, was in other ways inconvenient and very expensive.
About the same time certain other reforms, obvious as they seem to us
since the days of Florence Nightingale, were tried in various places,
tending to more careful organization and to greater cleanliness; but
till the cause of the mischief could be discovered, only varying results
could be obtained, and no real victory could be won. Hence a radical
policy like Simpson's met with considerable support. In days when many
surgeons submitted despairingly to what they regarded as inevitable, it
was an advantage to have any one boldly advocating a big measure; and
Simpson had sufficient prestige in Edinburgh and outside to carry many
along with him. But before 1869 another line of attack had been
initiated from Glasgow, and Lister was already applying principles which
were to win the battle with more certainty of permanent success.
Glasgow was no more free from these troubles than other great towns; in
fact it suffered more than most of them. With its rapid industrial
development it had already in 1860 a population of 390,000. Its streets
were narrow, its houses often insanitary. In the haste to make money its
citizens had little time to think of air and open spaces. The science of
town-planning was unborn. Its hospital, far from having any special
advantage of position, was exposed to peculiar dangers. It lay on the
edge of the old cathedral graveyard, where the victims of cholera had
received promiscuous pit-burial only ten years before. The uppermost
tier of a multitude of coffins reached to within a few inches of the
surface. These horrors have long been swept away; but, when Lister took
charge of his wards in the Infirmary, they were infected by the
poisonous air generated so close at hand, and in consequence they
presented a gruesome appearance. The patients came from streets which
often were foul with dirt, smoke, and disease, and were admitted to
gloomy airless wards, where pyaemia or gangrene were firmly established.
In such an environment certain death seemed to await them.
Though his heart must have sunk within him, Lister set himself bravely
to the task of fighting these grim adversaries. For two years, indeed,
he was chiefly occupied with routine work and practical improvements;
but he continued his speculations, and in 1861 an article on amputations
which he contributed to the _System of Surgery_, a large work in four
volumes published in London, showed that he had not lost his power of
surveying questions broadly and examining them with a fresh and original
insight. He was not in danger of letting his mind be swamped with
details, but could put them in their place and subordinate them to
principles; and his article is chiefly directed to a philosophical
survey which would enable his readers to go through the same process of
education which he had followed out for himself. Sir Hector Cameron, the
most constant of his Glasgow disciples, once illustrated this
philosophic spirit from a passage in Cicero contrasting the many
scientists who 'render themselves familiar with the strange' (not
realizing that it is strange or needs explanation) with the few who
'render themselves strange to the familiar'--who stand away from the
phenomena to which every one has become too accustomed and examine them
afresh for themselves. In Lister he recognized the peculiar gift which
enabled him to rise superior to his subject, and to interpret what was
to his colleagues a sealed book. In these days, among the too familiar
scourges of the hospital, his work was perpetually putting questions to
him; to a man whose mind was open the answer might come at any moment
and from any quarter.
As a fact, already, far from his own circle and for a long while out of
his ken, there was working in France the most remarkable scientist of
the century, Louis Pasteur, who more than once put his scientific
ability at the disposal of a stricken industry, and in his quiet
laboratory revived the industrial life of a teeming population. A
manufacturer who was confronted with difficulties in making
beetroot-alcohol and was threatened with financial ruin, appealed for
his help in 1856; and Pasteur spent years on the study of fermentation,
making countless experiments to test the action of the air in the
processes of putrefaction, and coming to the conclusion that the oxygen
of the air was not responsible for them, as was widely believed. He went
further and reached a positive result. He satisfied himself that
putrefaction was set up by tiny living organisms carried in the dust of
the air, and that the process was due to what we now familiarly term
'germs' or 'microbes'. The existence of these infinitesimal creatures
was known already to scientists, but their importance was not grasped
till Pasteur, in the years 1862 to 1864, expounded the results of his
long course of studies. He himself was no expert in medicine, but his
discovery was to bear wonderful fruit when it was properly applied to
the science of health and disease. Lister's study of open wounds, his
observation of the harm done to the tissues in them when vitality was
impaired, and of the value of protective scabs when they formed, enabled
him to see the way and to point it out to others. When in 1865 he first
read the papers which Pasteur had been publishing, he found the
principle for which he had so long been searching. With what excitement
he read them, with what suddenness of conviction he accepted the
message, we do not know; he has left no record of his feelings at the
time: but it was the most important moment in his career, and the rest
of his life was spent in applying these principles to his professional
work.
With his mind thus fortified by the knowledge of the true source of the
mischief, realizing that he had to assist in a battle between the deadly
germs carried in the air and the living tissues trying to defend
themselves, Lister returned afresh to the study of methods. He knew that
he had to reckon with germs in the wound itself, if the skin was broken,
with germs on the hands and instruments of the operator, and with germs
on the dust in the air. He must find some defensive power which was able
to kill the germs, at least in the first two instances, without
exercising an irritating effect on the tissues and weakening their
vitality. The relative importance of these various factors in the
problem only time and experience could tell him. Carbolic acid had been
discovered in 1834 and had already been tried by surgeons with varying
results. At Carlisle it had been used by the town authorities to cope
with the foul odour of sewage, and Lister visited the town to study its
operation. In its cruder form carbolic proved only too liable to
irritate a wound and was difficult to dissolve in water. Lister tried
solutions of different strengths, and finally arrived at a form of
carbolic acid which proved to be soluble in oil and to have the
'antiseptic' force which he desired--that is, to check the process of
sepsis or putrefaction inside the wound. He also set himself to devise
some 'protective' which would enable Nature to do her healing work
without further interference from without. Animals have the power to
form quickly a natural scab over a wound, which is impermeable and at
the same time elastic. The human skin, after a slight wound, in a pure
atmosphere, may heal quickly; but a serious wound may continue open for
a long time, discharging 'pus' at intervals, while decomposition is
slowly lowering the vitality of the patient. Lister made numerous
experiments with layers of chalk and carbolic oil, with a combination of
shellac and gutta-percha, with everything of which he could think, to
imitate the work of nature. His inexhaustible patience stood him in good
stead in all these practical details. Rivals might speak contemptuously
of the 'carbolic treatment' and the 'putty method' as if he were the
vender of a new quack medicine; but at the back of these details was a
scientific principle, firmly grasped by one man, while all others were
groping in the dark.
[Illustration: LORD LISTER
From a photograph by Messrs. Barraud]
During 1866 and 1867 we see from his letters how he set himself to apply
the new principle first to cases of compound fracture and then to
abscesses, how closely and anxiously he watched the progress of his
patients, and how slow he was to claim a victory before his confidence
was assured. In July 1867, when he was just forty years old, he felt it
to be his duty to communicate what he had learnt and to put his
experience at the disposal of his fellow workers. He wrote then to _The
Lancet_ describing in detail eleven cases of compound fracture under his
care, in which one patient had died, one had lost a limb, and the other
nine had been successfully cured. This ratio of success to failure was
far in advance of the average practice of the time; but, for all that,
it is not surprising that he met with the common fate which rewards
pioneers in new fields of study. It is true that other reforms were
helping to reduce the number of fatal cases. Florence Nightingale had
led the way, and much had been learnt about hospital management. It was
possible to maintain that good results had been achieved by other
methods, and that Lister's proofs were in no way decisive. But there was
no need for critics to misapprehend the nature of his claims or to
introduce the personal element and accuse him of plagiarism. Sir James
Simpson revived the memory of a Frenchman, Lemaire, who had used
carbolic acid and written about it in 1860, and refused to give Lister
any credit for his discoveries. As a fact Lister had never heard of
Lemaire or his work; and, besides, the Frenchman had never known the
principles on which Lister based his work, nor did he succeed in
converting others to his practice. How little the personal question need
be raised between men of the highest character is shown by the relations
of Darwin and Wallace, who arrived independently and almost
simultaneously at their theory of the origin of species, Wallace put his
notes, the fruit of many years of work, at the disposal of Darwin; and
both continued to labour at the establishment of truth, each giving
generous recognition to the other's part in the work.
Unmoved then by this and other attacks, Lister continued his experiments
and spent the greatest pains, for years in succession, in improving the
details of his treatment. It would take too long to narrate his
struggles with carbolized silk and catgut in the search for the perfect
ligature, which should be absorbed by the living tissues without setting
up putrefaction in the wound; or his countless experiments to find a
dressing which should be antiseptic without bringing any irritating
substance near the vital spot. These latter finally resulted in the
choice of the cyanide gauze, which with its delicate shade of heliotrope
is now a familiar object in hospital and surgery. But one story is of
special interest because it shows us clearly how Lister, while clinging
to a principle, was ready to modify the details of treatment by the
lessons which experience taught him. It was on the advice of others that
he first introduced a carbolic spray in order to purify the air in the
neighbourhood of an operation. At first he used a small spray worked by
hand, but this was, for practical reasons, changed into a foot-spray and
afterwards into one worked by steam. One objection to this was that the
steam-engine was a cumbrous bit of apparatus to carry about with him to
operations; and Lister all his life loved simplicity in his methods.
Another was that the carbolic solution, falling on the hands of the
operator, might chill them and impair his skill in handling his
instruments. Lister himself suffered less in this way than most other
surgeons; with some men it was a grave handicap. The spectators at a
demonstration found it inconvenient, and in one instance at least we
know that the patient was upset by the carbolic vapour reaching her
eyes. This was no less a person than Queen Victoria, upon whom Lister
was called to operate at Balmoral in 1870. About the use of this
apparatus, which was an easy mark for ridicule, Lister had doubts for
some time; but it was not the ridicule which killed it, but his growing
conviction that it did not afford the security which was claimed for it.
He was hesitating in 1881; in 1887 he abandoned the use of the spray
entirely; in 1890 he expressed publicly at Berlin his regret for having
advocated what had proved to be a needless complication and even a
source of trouble in conducting operations. In adopting it he had for
once been ready to listen to the advice of others without his usual
precaution of first-hand experiments; in abandoning it he showed his
contempt for merely outward consistency in practice and his willingness
to admit his own mistakes.