Joseph Lister was born on 5 April 1827. There are lots of material about him available online that covers his life and work, so there is no point to rewrite the story. Instead I base my story on Lindsey Fitzharris’s book, which whole name is The Butchering Art. Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.
When anaesthesia was discovered, it helped the patients to go through the surgery without pain. But going through the operation was one thing, to survive and recover was a totally another thing.
As it turned out, the two decades immediately following the popularization of anesthesia saw surgical outcomes worsen. With their newfound confidence about operating without inflicting pain, surgeons became even more willing to take up the knife, driving up the incidences of postoperative infection and shock. Operating theaters became filthier than ever as the number of surgeries increased. Surgeons still lacking an understanding of the causes of infection would operate on multiple patients in succession using the same unwashed instruments on each occasion. The more crowded the operating theater became, the less likely it was that even the most primitive sanitary precautions would be taken. Of those who went under the knife, many either died or never fully recovered and then spent the rest of their lives as invalids. This problem was universal. Patients worldwide came to further dread the word “hospital”, while most skilled surgeons distrusted their own abilities. (Fitzharris, p. 17)
The above text is quoted from Dr. Lindsey Fitzharris‘s book, The Butchering Art, that was released in 2017. I was first thinking of using the book only as one source for my coming Lister article, but after reading it and writing down all the notes, I decided to use the book basically as my only source. In this way I can get a bit more visibility to this book as well, as I never gave it a presentation (that it would have deserved). And as I mentioned in the intro, there is no point to write about things that everyone can find on internet by googling Joseph Lister’s name. Anyway, back to the theme of this article.
On 21 December 1846 a rewarded surgeon, Robert Liston tested the efficacy of ether at the operating theatre at University College Hospital in London. Among the people who were gathered to witness the mid-thigh amputation under the influence of ether, was Joseph Lister, who would
soon embark on devoting the rest of his life to elucidating the causes and nature of postoperative infections and finding a solution for them. In the shadow of one of the profession’s last great butchers, another surgical revolution was about to begin. (Fitzharris, p. 18)
Joseph Lister was born in the village of Upton, in West Ham (then belonging to Essex) on 5 April 1827 as the fourth child of seven children of devoted Quaker parents Joseph Jackson and Isabella Lister. He knew already very young that he wanted to become a surgeon. At his teens he was drawing skeletons and labelling the bones in the cranium and of the hands and working on real thing as well, for example in a shape of a sheep head. In 1844 at the 17 years old, he started studying at University College London. Besides the medical studies, he completed an arts degree first (history, literature, mathematics and science).
During his medical studies he had suffered from smallpox (even though mild one) and he had started having doubts and was thinking if his vocation would lay with the Quaker ministry, but it was his father, who made him to continue in medical career. He had a one-year break from the studies because of mental breakdown and during the absence from the university he travelled around Britain and Europe. He was ready to come back in 1849. But the depression was following him his entire life.
At those days microscope was not yet considered as a useful device, but Lister trusted on this instrument that was a familiar device to him from his home as his father, Joseph Jackson Lister was “amateur opticist whose discoveries played an important role in perfecting the objective lens system of the microscope, elevating that instrument to the status of a serious scientific tool” (source). And like Lindsey Fitzharris writes in The Butchering Art, “[i]t was this very instrument that would eventually help him unlock the medical mystery that had been plaguing his profession for centuries”. (Fitzharris, p. 36)
In 1851 Lister was offered a position of surgical dresser to hospital’s senior surgeon, John Eric Erichsen. He continued his own studies with the microscope and sketched what he had seen using a camera lucida. He was also making full-colour clinical paintings of the patients.
This year he also had to make his first operation. Fitzharris is telling about it in her book. If you are interested in it, you can read the whole story online on Royal Society’s page, in an article that was released in 2013. Please click this.
In 1852 a hospital gangrene outbreak took place at University College Hospital. Lister debrided and cleaned the infected wounds with a highly caustic and toxic solution and the ulcers healed. He started thinking that behind the outbreak there had to be something in the wound itself, not in the air around the patients (miasma theory), even though he didn’t exclude that either. Lister put slough from an infected sore under the microscope lens and as he himself has noted,
I made a sketch of some bodies of pretty uniform size which I imagined might be the materies morbi [morbid substances]… the idea that it was probably of parasitic nature was at that early period already presented in my mind. (Fitzharris, p. 85; orig. in Joseph Lister, ‘The Huxley Lecture by Lord Lister, F.R.C.S., President of the Royal Society’, British Medical Journal, 6 Oct. 1900, p. 969)
Lister graduated and became fully qualified surgeon. In September 1853 Lister travelled to Edinburgh to meet Professor at Royal Infirmary, James Syme. Soon Lister became Syme’s right-hand man. Lister had planned to stay in Scotland only for a month, but soon he decided to stay a bit longer.
In the beginning of 1854, Lister was officially named as Syme’s house surgeon. When his house position as a surgeon ended, Lister planned to go back to London. But instead, he was elected a Fellow of the Royal College of Surgeons of Scotland and thus he was given a license to practice surgery in Edinburgh. In April 1856 Lister married Syme’s oldest daughter Agnes.
When working at the Royal Infirmary, Lister saw patients dying in the same way as in London, from gangrene, erysipelas, septicaemia and pyaemia. Lister wanted to understand, what was happening and started taking tissues from his patients and studying them with his microscope. At those days there were debates going on about the wound healing processes, which was good, which was bad; whether inflammation was part of a normal healing process or not, and what caused suppuration etc. Lister wanted to know, what caused the inflammation, about the process of inflammation. He started doing experiments with living tissue. His first guinea pigs were frogs. He wanted to understand “how inflammation affected blood vessels and blood flow in healthy limbs” (Fitzharris, p. 124) and he became frustrated because he couldn’t prevent and manage septic conditions in his patients.
To Glasgow
After several years in Edinburg, Joseph moved with his wife to Glasgow to be Regius Professor of Clinical Surgery at the University of Glasgow and soon he was elected a Fellow of the Royal Society. “The vote was a tribute to the originality of his research into inflammation and coagulation of the blood, which he presented in a series of papers to the Royal Society in 1860.” (Fitzharris, p. 135)
Lister was loved by his students, but he wanted to work as a surgeon, too. It took almost two years until he could start working at the Glasgow Royal Infirmary in 1861. And he continued with his research.
At the time Lister was among those who believed that “outbreaks of hospitalism were due to the poisonous atmosphere on the wards” (Fitzharris, p. 145) and thus he was pressing the cleanliness on the wards. But already at those days some doctors (regarding puerperal fever) had uttered thoughts that the problems might have caused by materies morbi. That it was in fact the doctors who transmitted the disease to patient. So, cleanliness was the thing, but at that point Lister hadn’t yet found the mechanism, if you like. By the 1860’s the mortality rates had reached the all-time high in the hospitals, as Fitzharris writes.
But then in 1864 Lister found Louis Pasteur’s research between fermentation and putrefaction and his thoughts that “putrefaction, like fermentation, was caused by the growth of minute microorganism that were carried through the air by dust” (Fitzharris, p. 158). Pasteur had a germ theory, but no-one started to study that further, put it into practice – until Lister heard about it. Fitzharris writes:
Lister came to the vital realization that he couldn’t prevent a wound from having contact with germs in the atmosphere. So he turned his attention to finding means of destroying microorganisms within the wound itself, before infection could set in. Pasteur had conducted a number of experiments that demonstrated that germs could be destroyed in three ways: by heat, by filtration, or by antiseptics. (Fitzharris, p. 159)
Lister concentrated on the last alternative. He understood now that it was the microbes that were behind the hospital infections. It was time to find an effective way to attack them. In the end the answer was carbolic acid (nowadays known as phenol). Lister had read about its use in the Carlisle sewage works to fight against the smell of garbage and “to render odorless nearby pastures that were irrigated with liquid waste” (Fitzharris, p. 161). While doing that the carbolic acid killed also “the protozoan parasites that had caused outbreaks of cattle plague in the livestock that grazed in these fields” (ibid.)
He started his experiments and after a couple of failures he decided to concentrate on compound fractures that usually led to amputation. In August 1865 he was treating a wound of an 11-year-old boy with a compound fracture with carbolic acid and the treatment was successful. The carbolic acid was the antiseptic that Lister had been searching. He published his findings regarding his experiments and treatments against septic with carbolic acid in The Lancet in 1867 and gave Pasteur the credits he deserved. His antiseptic system had reduced the suffering from infections and “[n]ot a single instance of pyemia, gangrene, or erysipelas had occurred on Lister’s wards since he had introduced his system”. (Fitzharris, p. 171)
Lister’s antiseptic system ended up in a real test when Lister had to do his first ever mastectomy to his sister as no-one else wanted to carry out such a big operation. As this was his first try, he practiced first with a corpse. In order to minimize the risks for hospital infection, Lister operated his sister at his home, on a dining table. After all the instruments were dipped into carbolic acid, Lister was ready to operate. All went well.
More about carbolic acid and Joseph Lister in an article called ‘Dr. Joseph Lister and the use of Carbolic Acid as Disinfectant’. You can read it here.
Back to Edinburgh and to America
In autumn 1869 Lister was elected to the chair of clinical surgery at the University of Edinburgh after Syme had suffered from a stroke and resigned his position there. Lister continued making experiments on the carbolic acid on putrefactive wounds and carbolized animal-ligatures (catgut). He spoke for sterilizing with carbolic acid everything from instruments to the hands. One of his inventions was a carbolic spray that was used to sterilize the air during the operation and while changing the dressings, too. “But it had another purpose as well. Lister believed that the spray would reduce the need for direct irrigation of the wound with carbolic acid, which often damaged the skin and increased the risk of inflammation and infection.” (Fitzharris, pp. 208–209). Below is a video provided by Royal College of Physicians and Surgeons of Glasgow showing how the carbolic spray worked.
Lister faced lots of critics in Britain, but his antiseptic treatment was welcome in continental. But little by little he got more and more supporters in his own country, too. When he was able to show that the number of deaths on his wards had decreased after he had started using carbolic acid, his system started to be used in London hospitals, too. And treating Queen Victoria definitely helped to gain acceptance for his method. But it was the United States, where his antiseptic system faced lots of resistance. As Fitzharris writes, in the States Lister’s techniques were even banned in several hospitals there.
In September 1876 Lister travelled to Philadelphia to attend the International Medical Congress, where he was invited to defend his methods. Lister explained that the “germ theory of putrefaction is the foundation of the whole system of antisepsis” (as quoted in Fitzharris’s book, p. 220), meaning that if the germs were destroyed during the operation and prevented to enter the wounds, no pus would form. But the feedback that he received was quite harsh. Fitzharris writes that one attendee thought that Lister was mentally unhinged and had a “grasshopper in the head”. (Ibid.) But if they thought that this would discourage Lister, they were wrong. Lister gave several lectures during his trip to San Francisco and performed an operation in New York City before ending his trip to America. He had, however, supporters too and managed to convince even some of those who had banned his antiseptic system earlier.
When Lister travelled to Scotland in 1853, he had planned to stay there for a month. He went back to London finally in 1877, when he was appointed professor of clinical surgery at King’s College.
To Lister the patients were not “cases” but “[e]very patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.” That was his golden rule. (Fitzharris, p. 140) One day he treated a little girl with an abscess of the knee. I quote this (again) from Fitzharris’s book:
After Lister treated and dressed her wound, the girl held up her doll to him. He gently took the toy from her and noticed that it was missing its tiny leg. The girl fumbled around under her pillow and – much to Lister’s amusement – produced the severed limb. He shook his head ominously as he inspected his newest patient. Lister turned to Guthrie [Lister’s house surgeon Douglas Guthrie, who had told this story] and asked for a needle and cotton. Carefully, he stitched the limb back onto the doll and with quiet delight handed it back to the little girl. (Fitzharris, p. 140)
Joseph Lister died on 10 February 1912. He is buried in Hampstead Cemetery.
I will quote here Lindsey Fitzharris’s sort of conclusion of Joseph Lister’s career and about the official accolades he was receiving in the final decades of his life:
Lister lived for many decades after his theories and techniques had been accepted, and he was eventually celebrated as a hero of surgery. He was appointed personal surgeon in ordinary to Queen Victoria [meaning it was a permanent position —]. He was awarded honorary doctorates from the Universities of Cambridge and Oxford. He was awarded the Boudet Prize for the single greatest contribution to medicine. [—] He was also knighted and made a baronet; he was elected president of the Royal Society; he was raised to peerage and titled Lord Lister of Lyme Regis; he helped found the medical research body that would later be named in his honor, the Lister Institute of Preventive Medicine; and ten years before his death he was made privy councillor and honored with the Order of Merit – all for his work in science and medicine. (Fitzharris, p. 229)
Lister is among us, so to speak, in everyday life, too. A product called “Listerine” is one example, but also one other worldwide known name that is familiar to people without any connection to medical world, originates from Lister’s work. Robert Wood Johnson has attended the above-mentioned medical congress in Philadelphia and there he heard first time of antisepsis. He founded with his two brothers a company that was named Johnson & Johnson. It was founded to manufacture the first sterile surgical dressings and sutures mass-produced according to Lister’s methods. (Fitzharris, p. 231)
I want to close my story with a video about Joseph Lister provided by The BMJ.
Text © Katriina Etholén
Extracts from the book © Lindsey Fitzharris
Lindsey Fitzharris’s book The Butchering Art is still available, so if you became interested, I can recommend the book.
Lindsey Fitzharris’s website.
For additional reading: ‘Joseph Lister’s Antisepsis System’ on the Science Museum page.
The cover photo: Joseph Lister, 1st Baron Lister [1827 – 1912] surgeon. Wellcome Collection. CC BY 4.0.
Tales From The Brazier's Grotto 