Joseph Lister 1st Baron Lister
(b. Upton, Essex, England, 5 April 1827;d. Walmer, Deal, Kent, England, 10 February 1912)
The antiseptic doctrines and practices developed by Joseph Lister in the mid-Victorian era transformed the ancient craft of surgery into an enlightened art governed by scientific disciplines. His methodical, conscientious determination to reduce the appalling mortality rates resulting from traumatic and postoperative sepsis in the surgical wards of hospitals, allied with extraordinary probity and charm of character, captured the devotion of adherents in many countries and eventually silenced opponents. During his lifetime surgery expanded tremendously in resources and scope; the terrified despair of prospective victims gave place to faith and confidence that injury could be remedied and suppuration averted; and Lister himself became widely acknowledged as one of mankind’s greatest benefactors.
Lister was the fourth child and second son of Quaker parents, Joseph Jackson Lister and the former Isabella Harris, who had four sons and three daughters, Several generations of the Lister family had lived in Yorkshire when Joseph Lister, the illustrious surgeon’s great-grandfather (whose parents had joined the Society of Friends), went to London about 1720 and set up as a tobacconist. His youngest son, John, acquired a vintnery from Stephen Jackson, his father-in-law. John’s only son, Joseph Jackson, left school at fourteen to become apprenticed to the prospering wine business. In his early thirties he married a schoolteacher about the years his junior, daughter of the headmistress of Ackworth Quaker School. In 1826 he purchased Upton House, a mansion set on seventy acres about five miles east of London. Here Joseph Lister was born. The estate remained the family home until his father’s death in 1869.
Lister’s pensive, handsome mother was an unfailing source of affection, guidance, and instruction to the young boy. His remarkable father had artistic talent and, despite meager schooling, became a good Latin scholar and achieved distinction in mathematics, particularly in application to optics. Joseph Jackson Lister’s work led to production of the achromatic microscope objective and to his election to fellowship in the Royal Society of London in 1832. The closeknit household was happy and lively, enjoying occasional fun. Amusements were restrained, however, and relaxations purposeful; and the high-mindedness of parents and neighboring Friends was reflected by scientists who occasionally visited Upton House for group discussions. Lister was introduced by his father to microscopy and to pursuits in natural history that gave him lifelong pleasure. As a child he macerated bones, dissected animals and articulated their skeletons, and announced his intention to become a surgeon. A close sympathy developed between father and son, the latter habitually writing home about his affairs and appreciating the shrewd paternal comments and counsel.
Lister attended two private schools, the first at Hitchin, where he was ahead of his year, especially in classics. At about thirteen he went to the Quaker school of Grove House, Tottenham, which emphasized mathematics, natural science, modern languages, and the writing of formal essays on various topics. (Lister’s subjects included chemistry, human osteology, and laughing gas.) He left school at seventeen with a well-rounded education that included considerable familiarity with the classics, some facility in French and German, and a punctiliousness in speech and writing that became his hallmark.
In 1844 Lister entered the nonsectarian University College, London. It presented no obstacles to registration on religious grounds; possessed a modern hospital and a distinguished medical faculty; and was dedicated to sober study. In three years he received his B.A. degree; but soon after he began to study medicine, he contracted smallpox. Premature return to work brought on nervous depression, necessitating a long holiday in 1848. He resumed his studies in London that autumn. In those days students interspersed their classes in botany, physics, and chemistry (subsequently termed “premedical” courses) with physiology and anatomy (“preclinical” courses), and with ward visits, as the opportunity offered. Lister’s painstaking system of learning and his retentive memory allowed him to profit from this system. He always showed talent for integrating and applying knowledge acquired from manifold sources.
In his first years as a medical student, Lister worked very seriously under austere living conditions. A more cheerful and wholesome life supervened when he became a hospital resident and met at close quarters intelligent young men of diverse backgrounds, some destined for prominent careers. Participating in the debating society and the hospital medical society, he attacked the homeopaths and read papers (never published) on hospital gangrene and on the use of the microscope in medicine. After being house physician to the cardiologist W. H. Walshe, he was house surgeon for nine months in 1851 to J. (later Sir John) Erichsen, Awarded many examination honors, in 1852 he received the M.B. degree of the University of London and the fellowship of the Royal College of Surgeons.
In his final years at University College, Lister was influenced particularly by two professors: the ophthalmic surgeon Wharton Jones—well-known for researches on inflammation—and the eminent physiologist William Sharpey. Under their guidance and example, and with his father’s practical encouragement, he launched some histological investigations. These studies, conducted before modern methods of section cutting and tissue staining were available, evoked the technical enterprise and tenacity that marked Lister’s subsequent microbiological researches and antiseptic practices. The first published report, “Observations on the Contractile Tissue of the Iris” (1853), confirmed R. A. von Kölliker’s claim that the iris comprises involuntary muscle and demonstrated that papillary size is controlled by two distinct muscles. Another report soon appeared, “Observations on the Muscular Tissue of the Skin” (1853), dealing mainly with involuntary muscles of the scalp. Both papers, illustrated by delicate camera lucida drawings, attracted favorable attention at home and abroad. Lister’s first experimental inquiry, begun shortly afterward (but unreported for four years), concerned the flow and absorption of chyle in the mesenteric lacteal of mice given indigo in their feed.
Although these microscopic excursions fascinated Lister, his interest in surgery wavered only briefly. He had been present at University College Hospital in December 1846, when Robert Liston performed the first major operation under ether anesthesia in Britain. Several years elapsed before the availability of anesthetics persuaded surgeons to broaden the scope and reduce the haste of their procedures-thus increasing the mortality from postoperative sepsis. Prolonged suffering and death often followed treatment of a minor disability. A conscientious surgeon-to-be might well be appalled at the unpredictable prospect for his patients, and saddened by the grim mortality associated with his calling. But Lister was undaunted; after nine years of studies at University College he was now twenty-six, and it was time to establish himself. Sharpey advised that after spending a month with James Syme, professor of clinical surgery at the University of Edinburgh—perhaps the most original and thoughtful surgeon of his day—Lister should broaden his experience by visiting famous Continental medical centers.
In September 1853 Lister was warmly received at Edinburgh by the brilliant, opinionated Syme, who entrusted him with so much responsibility at the infirmary that before long Lister decided to stay the winter. Syme appointed him supernumerary house surgeon and made him welcome in his household. Early in 1854 Lister became his resident house surgeon, a post that brought special privileges: twelve dressers to supervise, a wide choice of hospital patients to operate upon, and opportunities of assisting in his chief’s private practice. The close relationship between the two men was enhanced when Lister became engaged in July 1855 to Syme’s eldest daughter, Agnes. He resigned his membership in the Society of Friends (but continued to use the Quaker form of address to his parents and siblings) and later joined the Scottish Episcopal Church. The marriage took place in April 1856 and, although childless, was very happy. For nearly forty years his wife proved a devoted companion, an understanding helpmate, and a patient and competent amanuensis.
Late in 1854. an assistant surgeoncy at the Royal Infirmary fell vacant, and Lister was urged to apply for it. The duties of the appointment included giving a course on the principles and practice of surgery, which he painstakingly prepared and began to give in the autumn of 1855, although he was not elected to the post until a year later, shortly after returning with his wife from a prolonged wedding tour. (At such renowned medical centers as Pavia, Padua, Vienna, Prague, Würzburg, Leipzig, and Berlin he had met many well-known figures, particularly in the field of ophthalmic surgery, to which he was then attracted.) The new appointee zestfully undertook a second lecture course, on surgical pathology and operative surgery. He also conducted “public” operations at the Royal Infirmary—sometimes applauded by students—and extended his microscopic researches.
After presenting a paper entitled “On the Minute Structure of Involuntary Muscular Fibre” to the Royal Society of Edinburgh, Lister intensified his inquiries into inflammation, launched the previous year following “a most glorious night” at the microscope. He read three reports to the Royal Society of London in June 1857; they were published in its Philosophical Transactions (1858), the most important being “On the Early Stages of Inflammation.” This records the earliest vascular and tissue changes induced in the frog’s web by such irritants as hot water and mustard. He concluded and thereafter taught that “the primary lesion in inflammatory congestion” is a “suspension of function or temporary abolition of vital energy,” characterized by “adhesiveness” of the blood corpuscles. Led thence to investigate blood coagulation, he summarized current knowledge of this phenomenon in his Croonian lecture of 1863.
Lister’s reputation as an original and thorough investigator brought him election to fellowship of the Royal Society in 1860, when he was only thirty-three years old. His scrupulous concern to verify conclusions and give full weight to conflicting evidence is revealed in letters he wrote in 1857–1858 to William Sharpey. Lister’s genuine modesty and obvious integrity, and a capacity to inspire students with enthusiasm and respect for their calling, made him a natural candidate for the regius professorship of surgery at the University of Glasgow, which became vacant late in 1859. Syme persuaded him to apply and canvass for the post, and his appointment was confirmed early in 1860. Nearly seven formative years at Edinburgh thus closed with regretful congratulations from students and a testimonial dinner from colleagues.
Lister was broadly trained, well reputed, courageous and conciliatory, and in the prime of physical and mental vigor. Glasgow’s medical school was prosperous, with a talented and congenial faculty. Lister was initially handicapped, however, by lack of a hospital appointment, for the professorial chair did not automatically involve the surgeoncy at the Royal Infirmary. Nevertheless, he assumed heavy teaching and administrative duties, including the preparation of a daily lecture in systematic surgery for a class of 182 enthusiastic students. Characteristically, he renovated the students’ desks and redecorated the lecture theater at his own expense. He set up a meticulously detailed and troublesome system of marking each question in his written and oral examinations; became actively interested in arrangements for removal of the university to a new locality; and served and secretary of the medical faculty. Lister also wrote lengthy and valuable chapters on amputations and anesthetics for T.Holmes’s comprehensive System of Surgery (1860–1864), to which he was sole contributor from outside London. These undertakings left little time for the demands of private practice.
Lister worked even harder when elected in 1861 to take charge of the surgical wards at the Royal Infirmary. He explored the greater opportunities, more conservative procedures, and lessened shock offered by the advent of anesthesia. (He favored chloroform, discovered in 1847 by Sir James Y. Simpson, an eminent gynecologist at Edinburgh—who later attacked the antiseptic system.) During this period Lister invented several ingenious instruments, including a needle for silver-wire sutures, a hook for extracting small objects from the ear, a slender-bladed sinus forceps, and a screw tourniquet for compressing the abdominal aorta. Later he devised many kinds of dressings, ligatures, and drains for wounds. He was a cautious operator, deliberate and thorough rather than spectacular, but alert and resolute in an emergency. Broad-shouldered and of powerful physique, with very strong hands, Lister was yet extremely gentle ; and the most delicate manipulations, such as removal of a cataract or a urethral stone, were performed unfalteringly. His innovations-such as radical mastectomy for breast cancer, the wiring of fractured patellae and pegging of un-united fractures, and the revival of supra-pubic cystotomy-were a consequence of greater surgical boldness following the introduction of antiseptic techniques. Improved methods of amputating through the thigh or at the hip dated from the pre-antiseptic era, however, as did Lister’s practice of rendering the site of operation bloodless by elevating the involved limb before applying the tourniquet.
The manifold commitments and heavy routine were incompatible with Lister’s research aspirations. Moreover, tenure of his hospital appointment was limited to ten years. Hence, when the chair of systematic surgery at Edinburgh became vacant in 1864, he was persuaded to apply for it. His disappointment when James Spence was chosen became mingled with grief at the almost simultaneous death of his mother; but he involved himself in helping to select a site for Glasgow’s new College Hospital (the future Western Infirmity) and in preparing a pioneer paper, “Excision of the Wrist for Caries” (1865). This describes how, out of fifteen cases of tuberculosis of the wrist joint, at least the hands were spared from amputation and rendered functional.
Lister was dismayed that surgical progress should be blocked by the threat of erysipelas, septicemia, pyemia, or hospital gangrene. Admittance to the New Surgical Hospital portion of the Royal Infirmity meant courting unpredictable catastrophe. The morality from mutations, as in many other well-known hospitals, was around 40 percent. Abdominal surgery was seldom contemplated and was limited to ovariotomy, and the thoracic and cranial cavities were practically sacrosanct. Lister’s wards never assumed the frightful conditions that necessitated closure of other parts of the building—probably because he was unusually fastidious, demanded strict attention to rules of cleanliness, ensured good air circulation, and refused to tolerate overcrowding. Yet the sufferings of his patients were so heartrending that it sometimes seemed “a questionable privilege to be connected with the institution”.
In the early 1860’s Lister began declaring wound suppuration a form of decomposition. The prevailing medical doctrine about the cause of putrefaction derived from from Liebuig’s dictum (1839) that ordanic substances in the moist state and in the presence of oxygen undergo a peculiar from of combustion. Lie rode roughshod over the observations in 1837 of the physicist Charles Cagninard de la Tour and the physiologist Theodor Schwann that fermentative phenomena resulted from the multiplication of yeast cells. A subsequent generation of misguided surgeons had treated wounds systematically on the supposition that they should be shielded from the effects of atmospheric oxygen. One system encouraged scabformation through applications of powders, caustics, or fragrant balsams. Every surgeon had his favorite dressing, dry or wet. The alternative system entailed mechanical occlusion of the wound with agents such as collodion, adhesive plaster, and goldbeater’s skin.
Lister realized that oxygen could not be excluded from wounds, and he soon doubted its responsibility for provoking suppuration. His 1865 paper referred to the oral administration of potassium sulfite to a patient who developed fatal pyemia, “with the view of counteracting the poisonous effect of any septic matter already introduced into the circulation.” Further, when two persistent sores became gangrenous in a patient whose wrist he had successfully excised, the process was “checked by the application of carbolic acid….”
Thomas Anderson, professor of chemistry at Glasgow University, drew Lister’s attention in 1865 to the work and writings of Louis Pasteur. In several notable reports, especially “Mémoire sur Ies corpuscles organisés qui existent das l’atmosphère. Examcn de la doctrine des générations spontanées” (1861) and “Recherches sur la putréfaction” (1864), Pasteur had claimed that putrefaction was a fermentative process caused by living microorganisms carried on dust particles and transported by the air; that the air could be freed of these agents by filtration, heat, and other means ; that certain body fluids, such as blood and urine, would keep indefinitely without decomposing if collected and stored under sterile conditions ; and that spontaneous generation was a myth. These claims revealed startlingly to Lister the causes of wound sepsis and provided the key to banishment of hospital diseases. He always gladly acknowledged his indebtedness to Pasteur, as in the 1867 address “On the Antiseptic Principle in the Practice of Surgery” to the British Medical Association:
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.
In 1864 Lister learned that carbolic acid treatment of the sewage at Carlisle had rendered neighboring irrigated lands odorless and had destroyed entozoa that infected cattle grazing there. Procuring a sample of crude “German creosote” from his colleague Anderson, he used it (unsuccessfully) in March 1865 in the treatment of a compound fracture of the leg. The impure material, immiscible with water, was superseded by the less irritating crystalline carbolic acid—newly manufactured at Manchester by F. C. Calvert. This was soluble up to 5 percent in water but dissolved readily in such organic fluids as olive oil or linseed oil. Between August 1865 and April 1867, by means of these agents, Lister obtained results exceeding all expectations: of eleven cases of compound fractures of limbs, nine recovered. The main features of his antiseptic treatment were thorough cleansing of the wound with carbolic acid and its protection from airborne germs by a dressing soaked in the acid. The site was covered with a molded sheet of tin to diminish evaporation, around which absorbent material was packed to collect discharge. The dressings were changed daily and the tenacious crust of carbolized blood at the site of injury retouched with the acid.
Lister adapted his principle and technique to drainage of indolent abscesses (including a large psoas abscess), associated with tuberculous bones or joints. Until opened, such lesions generally contained no “septic organisms,” so it was unnecessary to introduce antiseptic into them. To protect against environmental living particles during and after surgical intervention, however, the overlying skin was dressed with rag soaked in a 1 : 4 solution of crystalline carbolic acid in boiled linseed oil. Under this “antiseptic curtain“the abscess was incised and its contents evacuated. To prevent persistent discharge from such abscesses becoming contaminated, Lister prepared an antiseptic putty by mixing ordinary whiting with carbolic acid solution in linseed oil. This was spread thickly upon tinfoil and secured over the site with adhesive plaster.
Lister described these remarkable advances in a classic series of reports in The Lancet, “On a New Method of Treating Compound Fracture, Abscess, etc., With Observations on the Conditions of Suppuration” (1867), which included two novel observations on the healing capacities of tissues rendered uninfected by antiseptic treatment. First, a carbolized blood clot, left undisturbed, became organized into living tissue by in growth of cells and blood vessels from surrounding parts. Second, in an aseptic wound, portions of dead bone were absorbed by adjacent granulation tissue. Encouraged by these results, Lister began to apply the antiseptic principle to surgical wounds toward the end of 1866. In August 1867, at the Dublin meeting of the British Medical Association, he announced that during the last nine months his wards—previously “amongst the unhealthiest in the whole surgical division of the Glasgow Royal Infirmary”—had been entirely free from hospital sepsis.
Lister’s accomplishments were viewed by his university colleagues with sympathetic interest and by his assistants with unfeigned admiration; but many fellow surgeons, unaccustomed to weighing scientific evidence and prone to polemics (in which Lister never engaged), were indifferent, skeptical, or even hostile. For example, the chief of an adjacent surgical ward at the Royal Infirmary evinced no interest whatever in Lister’s patients or methods. Others found his system too exactingly detailed or, overlooking crucial points of technique, performed ambitious operations with disastrous results. His detractors deplored the frequent changes in technique and questioned the significance of such unsettled rituals. They did not realize that every modification followed exhaustive tests, often conducted for into the night in Lister’s home laboratory. His “protective” oiled-silk dressing, which allowed secretions to escape while sparing skin and tissues from carbolic acid irritation, took great time and trouble to develop. For three decades Lister sought improvements in the catgut ligature-a quest that began in 1868 at Upton, where he ligated a calf’s carotid artery during the last Christmas holidays before his father died. The animal was killed one month later and the catgut absorption process examined microscopically.
Some misunderstandings arose because Lister chose compound fractures for preliminary trials of his antiseptic method, in view of their frequency in heavily industrialized Glasgow and of the extremely high mortality rate resulting from them. To his distress, carbolic acid often was looked upon as a specific nostrum against sepsis, rather than as a potent protective barrier behind which injured parts could exercise their natural recovery powers. He was blamed both when the agent failed through tardy or inadequate usage and when its careless or excessive application caused tissue devitalization or carbolic acid poisoning.
Although he disdained recrimination, Lister felt obliged to refute the allegation of a formidable opponent, Sir James Simpson, that he had plagiarized the work of French and German surgeons, especially of Jules Lemaire, a pharmaceutical chemist of Paris, whose book De l’acide phénique (1863) described the medical and surgical uses of carbolic acid, Simpson’s bitter attack began with a letter signed “Chirurgicus,” published in the Edinburgh Daily Review of 23 September 1867. This was reproduced unworthily in The Lancet, which a few weeks later published an article by Simpson, “Carbolic Acid and Its Compounds in Surgery,” insinuating that Lister was culpably ignorant of medical literature and had merely transplanted an established Continental system of treatement. The latter had never heard of Lemaire but with some difficult located a copy of his book. In a letter to The Lancet, Lister disavowed ever having claimed the first usage of carbolic acid in surgery and dismissed Lemarie’s work by stating: “The principles and practice which he mentions are such as sufficiently to explain the insignificance of the results.”
Simpson was Syme’s rival for leadership of the Edinburgh medical professions; but he resented the antiseptic doctrine chiefly because it could render superfluous his proposal to replace existing large hospitals with small disposable units—in order to combat “hospitalism” or hospital sepsis—as well as his “acupressure” method of arresting hemorrhage, which would remove a common cause of postoperative infection by dispensing with ligatures. According to Lister, efficient antisepsis permitted ligatures to be cut short and left within wounds, instead of dangling purulently outside.
Favorable reports in medical journals now began to counterbalance the opposition. Visitors, including emissaries from European professors, although sometimes shocked by Lister’s surgical temerity, were impressed by the results. Students, house surgeons, and assistants, such as Hector Cameron, were his most enthusiastic disciples and increasingly promoted the doctrine. In April 1868, in a well-received review of the antiseptic system for the Medico-Chirurgical Society of Glasgow, illustrated by clinical cases, Lister advocated the transient germicidal potency of the 5 percent aqueous solution of carbolic acid for initially cleansing a wound; the bland, more retentive oily preparation was reserved for external dressing. On this occasion he presented his first modified Pasteurian demonstration of the airborne nature of putrefactive germs. Several months previously he had boiled for five minutes three bent-necked flasks containing fresh urine and a similar flask with attenuated and shortened vertical neck. In the former flasks the urine remained unaltered, but in the other decomposition had occurred and microorganisms abounded. This classic demonstration was used repeatedly to illustrate that putrefaction was not due to atmospheric gases alone but to mechanically arrestive, viable particles floating in the air. (Lister wrote subsequently to his father, describing attempts to exclude airborne germs by sheathing amputation stumps in thin rubber.) Meanwhile, his Royal Infirmary colleagues remained aloof, supported by a management that attributed the lower surgical mortality to improvements in hygiene, diet, and nursing.
In 1866 Lister unsuccessfully applied for the chair of surgery at his alma mater, University College, London. Three years later he submitted his candidacy as successor to Syme(who had suffered a severe stroke), and in August 1869 was elected professor of clinical surgery at Edinburgh. Within a month his father developed a fatal illness. Syme died the following summer, a few weeks after Simpson.
Although Lister left Glasgow amid expressions of regret, shortly after his arrival in Edinburgh a discordant note was struck by publication of his article “On the Effects of the Antiseptic System of Treatment Upon the Salubrity of a Surgical Hospital” (1869). He contended that the prevailing deplorable conditions at the Glasgow Royal Infirmary, aggravated on the ground floor by adjacent pit burials of victims of the 1849 cholera epidemic, should be contrasted with the healthy conditions brought about in his men’s accident ward on that floor by antiseptic treatment. On this and other occasions when Lister’s ingenuous candor and reforming zeal bruised the sensitivities of others, he was apologetic and sought to make amends without sacrifice of principle or dilution of precept.
The next eight years in Edinburgh were the happiest of his life. He was summoned and warmly welcomed by faculty and students as the exponent of a liberating new doctrine; both his wisest counselor and fiercest opponent had died; and he had assured respect and independence. Comparatively wealthy since his father’s death, he bought a costly house in the finest square and eventually built up an extensive practice. Less onerous university duties allowed Lister to devote himself to perfecting and propagating his antiseptic system. This demanded unstinting personal attention to patients of every class, besides greatly expanded laboratory researches. Most of his important work on pure and applied bacteriology was done during these Edinburgh years.
In his introductory lecture Lister reviewed the researches of Pasteur and his precursors on atmospheric germs, emphasizing their role in putrefaction without mentioning antiseptic surgery. He thus challenged the claims of the professor of medicine at Edinburgh, John Hughes Bennett, a microscopist who (like Sir James Simpson) ridiculed microbes as “mythical fungi.” Lister’s belief in atmospheric bacteria as the principal source of wound contamination, reinforced by John Tyndall’s essay “On Dust and Disease,” led him in 1871 to recommend carbolic spray as a means of pervading the vicinity of surgical wounds with antiseptic. During the next decade various types of atomizers were added to the operating room paraphernalia. Hand sprays evolved into foot sprays, both types requiring relays of perspiring assistants. The “donkey engine,” a long-handled model mounted on a tripod, was easier to manipulate but very cumbersome. Eventually, a portable “steam spray” was manufactured in large numbers. These devices kept the patient, surgeon, and assistants in intimate contact with droplets of 1 : 40 aqueous solution of carbolic acid, which were inevitably inhaled, sometimes with toxic effects, although Lister denied that any of his patients suffered carbolic acid poisoning. His own skin was delicate, yet it tolerated the acid well. The operator’s hand went white and numb, however, and the ultrasensitive found the regimen impossible. Although Lister never tested the spray’s action experimentally, from the first he regarded it as a necessary evil. Eventually growing skeptical, he abandoned it in 1887.
Lister’s time and ingenuity were now devoted mainly to the improvement of wound dressings and to various bacteriological researches. Because carbolic acid was evidently an irritant, liable to interfere with tissue healing, he developed an impermeable “protective” of oiled silk covered with copal varnish for direct application to the wound. This was covered by an antiseptic plaster of four parts shellac and one part carbolic acid. He summarized the underlying principle thus in 1870: “An antiseptic to exclude putrefaction, with a protective to exclude the antiseptic, will by their joint action keep the wound from abnormal stimulus.” Soon afterwards he replaced the nonabsorbent lac plaster with carbolized, absorbent muslin gauze, which remained in vogue for many years. Besides the spray and dressings, in 1871 Lister introduced into British practice the rubber drainage tube, invented by P. M. E. Chaussaignac in France twelve years before. Shortly after becoming surgeon in ordinary in Scotland to Queen Victoria, he treated her at Balmoral for an axillary abscess, obtaining good results after inserting a small drainage tube into the incision.
The elaborate safeguards for wounds, devised on the supposition that “after being exposed even for a second to the influence of septic air, putrefaction would be pretty certain to occur,” contrasted with Lister’s simple personal precautions in the operating room. Removing his coat and rolling up his sleeves, he pinned a large towel (clean but unsterilized) over his waistcoat and trousers. He wore neither gown, nor mask, nor gloves. Two strengths of carbolic acid solution, 1 : 20 and 1 : 40, were kept in trays and basins, the stronger being used for preliminary hand washing, for cleansing the patient’s skin at the operative site, and for immersing instruments. The weaker lotion, held in saturated sponges, served for frequent hand-dipping during the operation.
Many of Lister’s microbiological studies, recorded on more than 400 foolscap sheets closely written by his wife or himself, were tests of his antiseptic system and methods, not intended for publication. Besides his 1868 address at Glasgow and the inaugural lecture “On the Causation of Putrefaction and Fermentation” (1869), his Collected Papers include six reports under the heading “Bacteriology,” two dating from this Edinburgh period. His lengthy address to the Royal Society of London in 1873, on the germ theory of putrefaction and other fermentative changes,was largely provoked by John Burdon-Sanderson’s report “On the Orgin and Distribution of Microzymes (Bacteria)in Water…” (1871), which clamied that bacteria are conveyed by water but not by air, and are killed by simple drying at 100°F. These contentions, if true, would have nullified Lister’s efforts to provide an “antiseptic atmosphere” in surgical practice. In unboiled human urine taken with antiseptic percecautions—a better medium than Pasteur’s 10 percent sucrose and yeast ash solution employed by Burdon-Sanderson—bacteria grew when drops of tap water were added and also after this medium had been exposed for some hours to room air. The resulting aerial flora included a yeast and a filamentous fungus. Lister mistakenly conculuded that the latter could develop into either the yeast or the bacteria.
He renewed this pleomorphist interpretation when subsequently reporting the behavior of two bacterial species and a filamentous fungus that developed in an exposed milk sample. One of the bacterial species soured and curdled milk. Early in 1874 Lister sent his article to Pasteur,who had noted this phenomenon in1857. The resulting correspondence initiated a lifelong mutual admiration. Pasteur’s delicately suggested explanation of these findings was duly acknoweledged: “Next to the promulgation of new truth, the best thing, I concive, that a man can do, is the recantation of a published error.”
Some false starts notwithstanding, Lister made several fruitful contributions to bacteriology. He noted morphological and fermentative variations undergone by microorganisms in different nutrient media, and he observed that bacterial metabolites of a proteinaceous fluid could be odorless, or devoid of putrefactive smell. He devised novel apparatus—lidded glassware, a sterilizable syringe-pipette, and the “hot box,” a pioneer autoclave providing diffuse dry heat of 300° F. By confirming, extending, and unequivocally sponsoring Pasteur’s fundamental contentions, he induced many British colleagues to reappraise the germ theory or to launch fresh inquiries.
Meanwhile, antiseptic surgery gained more adherents abroad than at home. In England its chief proponents were younger surgeons at hospitals in large provincial cities, such as Liverpool, Birmingham, and Manchester. In Scotland, Listerian techniques yielded highly successful results at Glasgow Royal Infirmary in the mid-1870’s when Hector Cameron and William Macewen became surgeons there. Alexcendrer Ogston of Aberdeen, who later discovered the pyogenic staphylococcus, was a staunch supporter. At Edinburgh the chief sympathizer among the senior staff was Thomas Keith, who with T. Spencer Wells of London had achieved a remarkably low mortality rate in ovariotomy, mainly through scrupulous attention to surgical cleanliness. After he adopted antiseptic techniques, Keith’s results improved. In London, with few exceptions, apathy had given place to opposition. This trend, encouraged by the influential The Lancet, stemmed from various factors, including plain prejudice, misconceptions about details of the antiseptic ritual, Florence Nightingale’s campaign to improve hospital hygiene, and H. Charlton Bastian’s revival of the spontaneous-generation obsession.
In Germany, Karl Thiersch of Leipzig successfully adopted Lister’s system as early as 1867. A simplified form of antiseptic treatment for battle wounds in the Franco-Prussian War gave disappointing results; but Richard von Volkmann became a doughty devotee after 1872, when his hospital at Halle, overcrowded with wounded soldiers and so dreadfully infected that its closure was imminent, obtained astonishing benefits from Listerian techniques. Other prominent supporters included J. von Nussbaum of Munich, A. Bardeleben and A. W. Schultze of Berlin, and Friedrich von Esmarch of Kiel. The particularly strong support for Lister’s methods in Germany was attributed by some British surgeons to that country’s less advanced state of sanitary science.
Among the earliest foreign visitors to became enthusiastic disciples were M. H. Saxtorph of Copenhagen and J. Lucas-Championnière of Paris (author of the first manual of antiseptic surgery). Other Europen adherents included Theodor Kocher in Bern and J. W. R. Tilanus in Amsterdam. Enrico Bottini’s use of carbolic acid as a surgical antiseptic at Novara, Italy, reported in “Dell’acido fenico nella chirurgia pratica e nella tassidermia” (1866), was unknown to lister and was generally ignored.
The reality of Lister’s fame abroad became obvious in 1875, during a much feted European tour with his wife, his brother Arthur, and other relatives. The Lancet termed his progress through the university towns of Germany “a triumphal march.” In America antiseptic surgery made slow progress until Lister personally expounded his doctrine, as president of the Surgical Section, to the 1876 International Medical Congress at Philadelphia. Again accompanied by his wife and brother, he paid pre-Congress visits to United States to San Francisco, and met enthusiastic receptions in Boston and New York.
Meanwhile, Lister campaigned against the antivivisectionists, whose allegations caused the appointment of a royal commission in 1875. To the queen’s plea that he should condemn vivisection, he responded by declaring “legislation on this subject is wholly uncalled for.” He deplored the inconsistency of those who approve fox-hunting but brand as cruel the animal experimenter who takes “every care to render the pain as slight as is compatible with the high object in view”; and he reaffirmed his stand in evidence before the commission. Appointed to the General Medical Council in 1876, Lister was designated chairman of its committee to report on the Cruelty to Animals Bill before Parliament. The final act contained relaxations for which Lister was largely responsible.
Between 1870 and 1876 Lister published the papers on antiseptic surgery, including a major address to the British Medical Association at Plymouth in 1871, and presented masterful demonstrations before that organization at Edinburgh in 1875. Notwithstanding these evangelistic efforts and successful European and North American missions, the persistent hostility of many London surgeons represented a challenge to Lister (himself a Londoner) to carry his gospel to the metropolis. The opportunity came early in 1877, when he was approached as possible successor to Sir William Fergusson, titular professor of surgery at King’s College, who had died. His students, hearing rumors, presented a complimentary memorial with 700 signatures, begging him to remain. An impromptu response, in which Lister incautiously called the London system of teaching clinical surgery “a mere sham” that largely neglected “magnificent opportunities of demonstrative teaching” appeared the next day in the Edinburgh and London newspapers. When castigated by The Lancet, Lister temperately explained that his words were not intended as a personal affront. Negotiations were resumed, and in June he was elected to a newly created chair of clinical surgery.
Lister’s brilliant interlude in Edinburgh ended in his fiftieth year, without fuss or fanfare. In London he settled in Park Crescent, near Regent’s Park and the Botanical Gardens, where he liked to roam and meditate. A nursing home for private patients was also close. Among the four-man team accompanying him were Watson Cheyne and John Stewart of Halifax, Nova Scotia, who as house surgeons disconsolately faced two dozen empty beds at King’s College Hospital instead of six wards and up to seventy patients at Edinburgh, The nursing sisters of St. John were uncooperative because the Listerian regimen conflicted with their time-honored routine. Eager lecture audiences of more than 400 auditors had dwindled to fewer than twenty listless students who feared examination penalties for airing antiseptic doctrines.
Without complaining, Lister overcame student apathy, nursing obstructiveness, and much professional opposition. James Spence, his former Edinburgh rival, and Robert Lawson Tait, the Birmingham gynecologist, remained antagonistic; but the latter’s truculence was largely neutralized by support from another expert ovariotomist, Spencer Wells. During a debate on antiseptic surgery at St. Thomas’ Hospital in December 1879, Lister fulfilled William Savory’s demands, echoed in The Lancet, for statistical data justifying his claims. Thereafter the few loyal but inarticulate followers of “Listerism” in London, backed by the British Medical Journal were reinforced by the outspoken advocacy of such leading surgeons as William MacCormac, Jonathan Hutchinson, John Wood, and (a late convert) Sir James Paget.
Lister’s complete sincerity, pertinacious but conciliatory approach, and dramatic surgical achievements—such as the successful wiring of a broken kneecap-largely account for this transformation. Advances in bacteriology also strengthened the antiseptic doctrine. His introductory address at King’s College, “The Nature of Fermentation,” inferentially clinched the microbic etiology of putre-faction by linking the lactic acid fermentation of milk to growth of a specific bacillus, which he termed Bacterium lactis. With small inocula of this micro-organism, prepared in pure culture by a novel dilution method, he curdled boiled milk at will. An expanded lecture-demonstration on the lactic fermentation before the Pathological Society of London late in 1877 was his last major contribution to bacteriological research. For many years thereafter Lister maintained his laboratory for testing antiseptics, read the foreign literature punctiliously, and occasionally reviewed developments in microbiology; but he found restrictions on animal experiments a handicap and left the field to specialists.
His prestige at home was further enhanced by his celebrity abroad. Lister visited Paris in 1878 as president of the jury on medical matters at the Universal Exhibition, lectured (in French) at the Academy of Medicine, and met Pasteur. At the 1879 International Medical Congress in Amsterdam, he was acclaimed with unprecedented enthusiasm. He received honorary doctorates from Oxford and Cambridge in 1880. The queen appointed him surgeonin-ordinary in 1878 and conferred a baronetcy on him in 1883. Among the earliest foreign honors awarded him were the Boudet Prize (1881), for his application of Pasteur’s researches to the healing art, and the Prussian Ordre pour le Mérite (1885).
Robert Koch’s discoveries on the etiology of anthrax and wound infections (1876–1878) evoked Lister’s admiration. Correspondence ensued, and the Wundinfectionskrankheiten monograph was translated into English by Cheyne in 1880. Lister summarized this work, and Pasteur’s early experiments on immunity against fowl cholera, in masterly addresses on the relation of microorganisms to disease and inflammation, given at Cambridge and at the 1881 International Medical Congress in London. The Surgical Section of the Congress sponsored a symposium on the treatment of wounds, in which Lister stressed the defensive powers of the blood and tissues and spoke diffidently about the carbolic spray, lately declared superfluous in an article by P. Bruns of Tübingen, arrestingly titled “Fort mit dem Spray!” Both Pasteur and Koch attended the congress and at Lister’s instigation met at King’s College, where the latter demonstrated his gelatin medium for cultivating and isolating pure cultures.
Koch’s initial report on disinfection (1881) revealed that the antiseptic supremacy of carbolic acid was overestimated, at least as regards anthrax spores, on which mercuric chloride had for greater “disinfectant” (bactericidal) and “antiseptic” (bacteriostatic) actions. In 1884 Lister adopted external dressings impregnated with mercuric chloride; but these proved too irritating, and after five years of laboratory tests and manufacturing problems he recommended that the outer gauze dressing should contain the double cyanide of mercury and zinc. The frequent modifications in Listerian technique were now approved by The Lancet, as evidence that the paramount issue was the principle of antisepsis, rather than the peculiar virtues of any given antiseptic. Lister kept faith in his favorites, however; an address in 1893, “The Antiseptic Management of Wounds,” extolled the manifold virtues of 1 : 20 carbolic acid.
Developments in some German hospitals and clinics took another direction. Further studies from Koch’s laboratory, evaluating the bactericidal power of dry heat and the greater efficiency of steam sterilization for inert objects, coincided with increased awareness (anticipated earlier by Lister) that chemical antiseptics are liable to damage natural healing mechanisms, notably the phagocytic phenomenon first described in 1883 by Elie Metchnikoff. Berlin’s leading surgeon, Ernst von Bergmann, and his assistant Curt Schimmelbusch became apostles of “aseptic” surgery. They proclaimed great respect for Lister, although the ritualistic details and expensive paraphernalia published by Schimmelbusch in a text on aseptic surgery (1892) tended to disparage Listerism as outmoded.
To satisfy himself that the full-fledged aseptic tenets were feasible, Lister removed a tumor successfully “without contact of any antiseptic material with the wound.” He deplored the pretense that aseptic surgery completely obviates antiseptics and contended that its techniques, to achieve results comparable with his own, entailed greater care and trouble, as well as compelling hospitalization. He considered the terms “antisepsis” and “asepsis” to be interchangeable and kept aloof from extremist viewpoints, but he unwaveringly upheld the basic doctrine common to both systems. On details of antiseptic technique he was more pliable. The spray was renounced when he realized that the great majority of atmospheric microbes were neither pathogenic nor eliminated by carbolic acid droplets. In his address to the 1890 International Medical Congress in Berlin, “The Present Position of Antiseptic Surgery,” he commented: “As regards the spray, I feet ashamed that I should ever have recommended it….” The tributes paid him at this congress nevertheless proved “almost overpowering.” Next year, at the International Congress of Hygiene in London, Lister presided over the exceptionally well-attended Bacteriology Section; and a galaxy of delegates dined at Park Crescent. In 1892 he reached retirement age and relinquished the King’s College chair, but agreed to retain charge of his wards for another year. That December he represented the Royal Societies of London and Edinburgh at the Sorbonne ceremonies commemorating Pasteur’s jubilee. The artist J. A. Rixens captured the memorable scene as Lister stepped forward to embrace Pasteur after completing his eulogy.
Lister and his wife took frequent holidays in the British Isles and on the Continent. They enjoyed collecting flowers and studying wildlife, and kept diaries about these interludes. In the spring of 1893, at Rapallo, Lady Lister contracted pneumonia and died four days later, leaving her husband bereft of all intimate daily companionship and overwhelmed by sudden grief. He fulfilled the commitment to King’s College Hospital; but his private practice almost vanished, his laboratory experiments languished, and he generally avoided social gatherings. Lucy Syme, a sister-in-law who had often stayed with them, lightened the solitude by keeping house for him. Although Lister never ceased to mourn his wife, personal sadness was not allowed to interfere with public duty. In the following decade he filled many highly responsible offices with appropriate dignity and learning.
Elected foreign secretary of the Royal Society late in 1893, Lister became president two years later. His wide reading, logical exposition, and acute grasp of public health issues were apparent in five annual presidential addresses, which dealt mainly with developments in medical and veterinary sciences, particularly in microbiology. In 1896 Lister’s presidential address to the British Association, “The Interdependence of Science and the Healing Art,” included his first public explanation of Pasteur’s scientific influence upon his surgical practices, and also his last major allusion to antisepsis.
Lister’s concern for public health found expression in his persistent efforts to secure establishment of a British Institute of Preventive Medicine. Despite irrational opposition and studied indifference, it was incorporated in 1891 with Lister as chairman; and by 1895 it was producing diphtheria antitoxin under Armand Ruffer’s direction. In 1897, the centenary of the discovery of vaccination, Jenner’s name was attached to the Institute. Since this caused conflict with a vaccine lymph manufacturer, in 1903 it was finally named after Lister, who was its governing board’s first chairman and president for several years.
He was raised to the peerage in 1897, assuming the title Baron Lister of Lyme Regis, a small Dorsetshire town where he and his brothers had purchased a seaside house many years before. That autumn Lister attended the annual meetings of the British Association in Toronto and the British Medical Association in Montreal, afterward traveling across Canada by special railroad car with his brother and nieces. His final journey abroad was a voyage to South Africa in the winter of 1901–1902; but he continued to visit Lyme Regis, Buxton, and other health resorts in Britain, hoping to relieve his increasing rheumatic afflictions. Now a greatly venerated figure, he emerged from retirement only on such special occasions as that of his last great public address, the third Huxley lecture (1900)—a sweeping retrospect of his early physiological and pathological researches-or for his resourceful chairmanship of the session of the Second Tuberculosis Congress in London (1901), when Koch asserted that bovine tuberculosis was a negligible hazard to human health. Disappointed at Koch’s premature disclosure of tuberculin ten years before, Lister unhesitatingly revealed flaws in his present argument.
In 1903, at Buxton, Lister apparently suffered a slight stroke, which hampered walking and mental effort; but he recovered sufficiently to deal with matters of personal import. For example, in 1906 he refuted the allegation that his antiseptic system was derived from the work of I. P. Semmelweis; and in 1907 he actively cooperated with friends in editing his Collected Papers to memorialize his eightieth birthday. This anniversary was celebrated in many countries and Lister received innumerable congratulatory messages. His last public appearance was at the Guildhall a few weeks later, to receive the freedom of the City of London.
Lister and his sister-in-law moved in 1908 to the small town of Walmer, on the Kentish coast. The bracing air, however, failed to renew his strength; his sight and hearing became impaired; and fell into a gradual, prolonged decline. The end came almost imperceptibly. A widespread desire that Lister should be buried in Westminster Abbey was overridden by his own wish to be interred beside his wife in West Hampstead Cemetery. An impressive funeral service was nonetheless held in the Abbey, where a medallion by Sir Thomas Brock, one of the finest of Lister’s many portraits and busts, commemorates his fame.
During later years Lister’s multiplying tributes included the freedom of Edinburgh, Glasgow, and London; honorary doctorates from many British and foreign universities; corresponding or honorary membership in some sixty scientific and medical societies in various countries; and the Copley and several other medals. He became sergeant-surgeon to Queen Victoria in 1900 and, at his accession, to King Edward VII, who appointed Lister to the newly instituted Order of Merit and also to the Privy Council.
In analyzing Lister’s personality, his chief biographer, Sir Rickman Godlee, was restrained by his uncle’s expressed desire for a simple record of his contributions to science and surgery. His faults were trivial and easily explained. He was unpunctual ; he often greatly exceeded the allotted time in addresses and discussions ; and he embarrassed patients and professional colleagues by refusing to specify his fees. He epitomized himself in a letter to his father soon after first arriving in Edinburgh: “I am by disposition very averse to quarrelling and contending with others,” he wrote, “but at the same time I do love honesty and independence.” The rare nobility of his character inspired one of his ward patients, the poet W. E. Henley, to express his admiration in the sonnet “The Chief,” which compared him to Hercules, “Battling with custom, prejudice, disease....” A fellow surgeon, Sir Frederick Treves, provided a fitting epitaph for his accomplishments:
Lister created anew the ancient art of healing; he made a reality of the hope which had for all time sustained the surgeon’s endeavours; he removed the impenetrable cloud which had stood for centuries between great principles and successful practice, and he rendered possible a treatment which had hitherto been but the vision of the dreamer.
I. Original Works. The only ed. of Lister’s works is The Collected Papers of Joseph, Baron Lister, 2 vols. (Oxford, 1909). This was prepared by a committee consisting of Hector C. Cameron, W. Watson Cheyne, R. J. Godlee, C. J. Martin, and D. Williams, in response to the widely expressed desire, on Lister’s eightieth birthday, for some appropriate memorial of “a life so rich in benefits to mankind.” The committee was advised by Lister on the selection of papers and addresses—about half of all his publications—which he himself thought possessed permanent interest and importance. Vol. I contains 16 contributions to physiology (pt. 1), and 9 to pathology and bacteriology (pt. 2). In vol. 11 are 26 publications on the antiseptic system (pt. 3), and 6 on surgery (pt. 4), while pt.,5 comprises 4 addresses and communications on miscellaneous topics, including an obituary tribute to his father.
Lister’s publications were incompletely compiled by C. W. W. Judd in his prize essay on the life and work of Lister (see below); by J. Chiene in the Lister no. of the British Medical Journal (1902), 2 , 1853–1854; and by C. N. B. Camac in Epoch-Making Contributions to Medicine, Surgery and the Allied Sciences (London, 1909), appended to a repr. of “On the Antiseptic Principle in the Practice of Surgery,” pp. 9–22. A more extensive bibliography, supplemented by biographical articles, precedes (pp. 9–27) the repr. of three of Lister’s papers on antisepsis in Medical Classics, 2 (1937–1938), 28–101. The Souvenir Handbook of the Lister Centenary Exhibition at the Well-come Historical Medical Museum (London, 1927), pp. 155–166, offers the most complete record of his published work, numbering more than 120 items. None of these sources is free from errors.
Reports on researches in physiology and pathology include “Observations on the Contractile Tissue of the Iris,” in Quarterly Journal of Microscopical Science,1 (1853), 8–17; “Observations on the Muscular Tissue of the Skin,” ibid., 262–268; “On the Flow of Lacteal Fluid in the Mesentery of the Mouse,” in Report of the 27th Meeting of the British Association for the Advancement of Science (Dublin, 1857), 114; “On the Minute Structure of Involuntary Muscle Fibres,” in Transactions of the Royal Society of Edinburgh, 21 (1857), 549–557; “On the Early Stages of Inflammation,” in Proceedings of the Royal Society, 8 (1857), 581–587; “An Enquiry Regarding the Parts of the Nervous System Which Regulate the Contractions of the Arteries,” in Philosophical Transactions of the Royal Society, 148 (1858), 607–625; “On the C’utaneous Pigmentary System in the Frog,” ibid., 627–643; “Spontaneous Gangrene From Arteritis and the Causes of Coagulation of the Blood in Diseases of the Blood-Vessels,” in Edinburgh Medical Journal, 3 (1858), 893–907; “Preliminary Account of an Enquiry Into the Functions of the Visceral Nerves, With Special Reference to the SoCalled ’Inhibitory System,’” in Proceedings of the Royal Society,9 (1859), 367–380; “Some Observations on the Structure of Nerve-Fibres,” in Quarterly Journal of microscopical Science, 8 (1860), 29–32, written with W. Turner but with “Supplementary Observations” by Lister, 32–34; “Notice of Further Researches on the Coagulation of the Blood,” in Edinburgh Medical Journal, 5 (1860), 536–540; “Coagulation of the Blood,” in Proceedings of the Royal Society, 12 (1863), 580–611, the Croonian lecture; and “Address on the Value of Pathological Research,” in British Medical Journal (1897), 1 , 317–319.
Lister’s earlier papers on the antiseptic treatment in surgery include “On a New Method of Treating Compound Fracture, Abscess, etc., With Observations on the Conditions of Suppuration,” in Lancet (1867), 1 , 326–329, 357–359, 387–389, 507–509, and 2 , 95–96; “On the Antiseptic Principle in the Practice of Surgery,” ibid., 353–356; “On the Antiseptic Treatment in Surgery,” in British Medical Journal (1868), 2 , 53–56, 101–102, 461–463, 515–517, and (1869), 1 , 301–304—these three reports are repr. in German in Karl Sudhoff’s Klassiker der Medizin, no. 17 (Leipzig, 1912); “Observations on Ligature of Arteries on the Antiseptic System,” in Lancet (1869),1 , 451–455; “On the Effects of the Antiseptic System Upon the General Salubrity of a Surgical Hospital,” ibid., (1870), 1 , 4–6, 40–42; “The Glasgow Infirmary and the Antiseptic Treatment,” ibid., 210–211, letter to the editor; “Remarks on a Case of Compound Dislocation of the Ankle, With Other Injuries, Illustrating the Antiseptic System of Treatment,” ibid., 404–406, 440–443, 512–513; “Further Evidence Regarding the Effects of the Antiseptic Treatment Upon the Salubrity of a Surgical Hospital,” ibid., 2 , 287–289; “A Method of Antiseptic Treatment Applicable to Wounded Soldiers in the Present War,” in British Medical Journal (1870), 2 , 243–244; “On Recent Improvements in the Details of Antiseptic Surgery,” in Lancet (1875), 1 , 365–367, 401–402, 434–436, 468–470, 603–605, 717–719, 787–789; and “Clinical Lecture Illustrating Antiseptic Surgery,” ibid. (2879) 2, 901–905.
Lister’s chief publications on pure and applied bacteriology are “Introductory Lecture” (delivered at the University of Edinburgh, 8 Nov. 1869), in British Medical Journal (1869), 2, 601–604; “The Address in Surgery” (at the 39th annual meeting of the British Medical Association, Plymouth), ibid. (1871), 2 , 225–233; “A Further Contribution to the Natural History of Bacteria and the Germ Theory of Fermentative Changes,” in Quarterly Journal of Microscopical Science, n.s. 13 (1873), 380–408; “A Contribution to the Germ Theory of Putrefaction and Other Fermentative Changes, and to the Natural History of Torulae and Bacteria,” in Transactions of the Royal Society of Edinburgh, 27 (1875), 313–344; “On the Nature of Fermentation,” in Quarterly Journal of Microscopical Science, n.s. 18 (1878), 177–194; “On the Lactic Fermentation, and Its Bearings on Pathology,” in Transactions of the Pathological Society of London, 29 1878), 425–467; “On the Relation of Microorganisms to Disease,” in Quarterly Journal of Microscopical Science, n.s. 21 (1881), 330–342; “On the Relations of Minute Organisms to Unhealthy Processes Arising in Wounds, and to Inflammation in General,” in Transactions of the 7th InternationalMedical Congress, I (London, 1881), 1311–1319; and “The Causes of Failure in Obtaining Primary Union in Operation Wounds, and on the Methods of Treatment Best Calculated to Secure It” (discussion), ibid., II , 369–383. (Many of the reports in this and the preceding paragraph appeared in French in G. Borginon, trans., Oeuvres réunies de chirurgie antiseptique et théorie des germes [Paris, 1882].
Reports of progress in antiseptic techniques include “Corrosive Sublimate as a Surgical Dressing,” in Lancet (1884), 2 , 723–728; “A New Antiseptic Dressing,” ibid. (1889), 2 , 943–947; “On Two Cases of Long-Standing Dislocation of Both Shoulders Treated by Operation; With Further Observations on the Cyanide of Zinc and Mercury,” ibid. (1890), 1 , 1–4; “An Address on the Present Position of Antiseptic Surgery,” in British Medical Journal (1890), 2 , 377–379; “An Address on the Antiseptic Management of Wounds,” ibid, (1893), 1 , 161–162, 277–278, 337–339; “On Early Researches Leading up to the Antiseptic System of Surgery,” in Lancet (1900), 2 , 985–993, the Huxley lecture; “Note on the Preparation of Catgut for Surgical Purposes,” ibid. (1908), 1 , 148–149; and “Remarks on Some Points in the History of Antiseptic Surgery,” ibid., 1815–1816.
Important and characteristic writings on surgery are “Report of Some Cases of Articular Disease Occurring in Mr. Syme’s Practice, Illustrating the Advantages of the Actual Cautery,” in Monthly Journal of Medical Science, 19 (1854), 134–137; “On Excision of the Wrist for Caries,” in Lancet (1865), 1 , 308–312, 335–338, 362–364; “Clinical Lecture on a Case of Excision of the Knee-Joint, and on Horsehair as a Drain for Wounds; With Remarks on the Teaching of Clinical Surgery” (delivered at King’s College Hospital, 10 Dec. 1877), in Lancet (1878), 1 , 5–9;” A Case of Multiple Papillomatous Growths in the Larynx, Extirpated by Complete Laryngotomy; Removal of the Whole Length of Both True and False Vocal Cords; Preservation of the Voice; Co-existence of Thoracic Aneurism,” in Transactions of the Clinical Society of London, 11 (1878), 104–113, written with J. B. Yeo; “An Address on the Treatment of Fracture of the Patella,” in British Medical Journal(1883), 2 , 855–860; “Amputation,” in Holmes’s System of Surgery, 3rd ed.,III(London, 1883); “Anaesthetics” (pt. 1 written in 1861, pt. 2 in 1870, pt. 3 in 1882), ibid. “Remarks on the Treatment of Fractures of the Patella of Long Standing,” in British Medical Journal (1908), 1 , 849–850.
Miscellaneous writings of lasting interest include “Obituary Notice of the Lateloseph Jack son Lister, F.R.S., With Special Reference to His Labours in the Improvement of the Achromatic Microscope,” Monthly Microscopical Journal,3 (1870), 134–143; “On the Coagulation of the Blood in Us Practical Aspects,” in British Medical Journal (1891) 1 , 1057–1060; “On the Relations of Clinical Medicine to Modern Scientific Development,” ibid. (1896), 2, 733–741; “Presidential Address Before the British Association for Advancement of Science,” in Science, n.s. 4 (1896), 409–429; “Presidential Address at the Anniversary Meeting of the Royal Society,” in Year-Book of the Royal Society (London, 1900), 144–156; “On Recent Researches With Regard to the Parasitology of Malaria,” in British Medical Journal (1900), 2 , 1625–1627; and the intro. to Stephen Paget’s Experiments on Animals (London, 1900), pp. xi-xii.
Many of Lister’s papers were published also in pamphlet form, or in more than one journal. Some appeared in foreign medical periodicals, trans, into German, French, or Italian. Handwritten letters from him are heirlooms in many families and are treasured by numerous institutions. Interesting small collections of his letters are in the Royal Faculty of Physicians and Surgeons, Glasgow, and the Osler Library, McGill University, Montreal. The former includes 14 unpub. letters (1897–1906) to Peter Paterson (later professor of surgery, Glasgow Royal Infirmary) about induced immunity to tuberculosis in experimental animals. Of the Osier Library letters, written to A. E. Malloch of Hamilton, Ontario, a former house surgeon at Glasgow Royal Infirmary, the earliest, dated 10 Sept. 1868, gives detailed instructions on treatment of a ward case and is reproduced in Godlee’s biography of Lister. The others, written during his last decade of life, thank Malloch for Canadian apples sent each Christmas to his former chief. Lister’s letters (1857–1864) to W. Sharpey, professor of physiology at University College, mostly concerning researches on inflammation, were published by C. R. Rudolf, “Eight Letters of Joseph (Lord) Lister to William Sharpey,” in British Journal of Surgery, 20 (1932), 145–164, 459–466.
Memorabilia of Lister are in many institutions, especially Edinburgh and Glasgow universities, and King’s College Hospital, London. The richest collections are at the Wellcome Institute of the History of Medicine, comprising some of his holiday diaries, manuscript notes on clinical surgery, and a volume of about 100 autograph letters; and at the Royal College of Surgeons of England, where the Lister Cabinet contains his “Common Place Book” (3 vols.), case notes, and other MSS, along with surgical instruments.
II. Secondary Literature. Tributes to Lister’s work during his lifetime include the editorials “Professor Lister in Germany,” in Lancet (1875), 1. 868; “The Surgical Use of Carbolic Acid,” ibid., 2 , 234–235; and “Lord Lister and the Antiseptic Method,” ibid. (1909), 1 , 1617–1620; J. Finlayson, “Lord Lister and the Development of Antiseptic Surgery,” in Janus, 5 (1900), 1–5, 57–63; L. L. Hill, “Some Personal Reminiscences of Lord Lister,” in Medical Record, 80 (1911), 327–329; C. C, W. Judd, “The Life and Work of Lister,” in Bulletin of the Johns Hopkins Hospital, 21 (1910), 293–304, the Lister Prize essay; W. W. Keen, “Lister on the Use of Animals in Research,” in Journal of the American Medical Association, 68 (1917), 53; H. Tillmanns, “Sir Joseph Lister,” in Nature, 54 (1896), 1–3, followed by an editorial on Lister, pp. 3–5; and Frederick Treves, “The Progress of Surgery,” in Practitioner, 58 (1897), 619–630.
The Lister jubilee no. of the British Medical Journal (1902), 2 , 1817–1861, commemorates the fiftieth anniversary of his entering the medical profession. Among the more noteworthy contributions are T. Annandale, “Early Days in Edinburgh,” pp. 1842–1843; O. Bloch, “On the Antiseptic Treatment of Wounds,” pp. 1825–1828; Hector C. Cameron, “Lord Lister and the Evolution of Modern Surgery. Glasgow, 1861–1869,” pp. 1844–1848; W. W. Cheyne, “Listerism and the Development of Operative Surgery,” pp. 1851–1852; J. Chiene, “Edinburgh Royal Infirmary, 1869–1877,” pp. 1854–1861; J. Lucas-Championnière, “An Essay on Scientific Surgery. The Antiseptic Method of Lister in the Present and in the Future,” pp. 1819–1821; and A. Ogston, “The Influence of Lister Upon Military Surgery,” pp. 1837–1838.
Obituaries include W. Watson Cheyne, “Lord Lister, 1827–1912,” in Proceeding of the Royal Society, 86B (1912–1913), i-xxi; J. Stewart, “Lord Lister,” in Canadian Journal of Medicine and Surgery, 31 (1912), 323–330; Frederick Treves, “Lister,” in London Hospital Gazette, 15 (1911–1912), 171–172; and also (unsigned) “Death of Lord Lister,” in Boston Medical and Surgical Journal, 166 (1912), 301–302; “Lord Lister,” in British Medical Journal, (1912), 1 397–402; “Lister,” in Glasgow Medical Journal, 77 (1912), 190–196; and “Lord Lister, O. M.,” in Lancet (1912), 1 , 465–472. Accounts of the obesequies are “Funeral of Lord Lister,” in British Medical Journal (1912), 1 , 440–446, followed by the editorial “The Maker of Modern Surgery,” pp. 447–448; and William Osler, “The Funeral of Lord Lister,” in Canadian Medical Association Journal, 2 , (1912), 343–344.
Among foreign-language obituaries are H. Coenen, “Joseph Lister † 1827–1912,” in Zeitschrift für Ärtzliche Fortbildung, 9 , (1912), 161–164; P. Daser, “Lord Lister,” in Münchener medizinische Wochenschrift, 59 , (1912), 480–481; A. Fraenkel, “Gedenkrede auf Lord Josef Lister,” in Wiener klinische Wochenschrift, 25 , (1912), 381–386; O. Lanz, “Joseph Lister †,” in Nederlandsch Tijdschrift voor Geneeskunde1 , 425–428; J. Lucas-Championnière, “Mort de Lord Lister,” in Journal de médecine et chirurgie pratique83 (1912), 129–135; and F. Trendelenburg, “Zur Erinnerung an Joseph Lister,” in Deutsche medizinische Wochenschrift, 38 (1912), 713–716.
Reminiscences and poshthumous tributes include those of Hector C. Cameron, Lord Lister 1827–1912. An Oration Delivered in the University if Chicago on Commemoration Day, 23rd June, 1914, (Glasgow, 1914); W. Watson Cheyne, “Lister, the Investigator and Surgeon,” in British Medical Journal (1925), 1 , 923–926; A. E. Malloch, “Personal Reminiscences of Lister,” in Canadian Medical Association Journal, 2 (1912), 502–506; J. Stewart, “First Listerian Oration,” ibid., 14 (1924), 1011–1040; and St. Clair Thomson, “A House-Surgeon’s Memories of Joseph Lister (Born April 5, 1827. Died February 10, 1912),” in Annals of Medical History, 2 (1919), 93–108.
The centenary of Lister’s birth occasioned many biographical articles in medical and scientific journals, including A. P. C. Ashhurst, “Centenary of Lister: Tale of Sepsis and Antisepsis,” in Annals of Medical History, 9 (1927), 205–221; John Bland-Sutton, “The Conquest of Sepsis,” in Lancet (1927), 1 , 781; W. Bulloch, “Lord Lister as a Pathologist and Bacteriologist,” ibid., 744–746 D. Cheever, “Lister: 1827–1927,” in Boston Medical and Surgical Journal, 196 (1927), 984–993; E. L. Gilcreest, “Lord Lister and the Renaissance of surgery,” in Surgical Clinics of North America, 7 (1927), 1117–1123; W. W. Keen, “Some Personal Recollections of Lord Lister,” in Surgery, Gynecology and Obstertrics, 45 (1927), 861–864; C. J. Martin, “Lister’s Contribution to Preventive Medicine,” in Nature, 119 (1927), 529–531; C. F. Painter, “Sir Joseph Lister. An Historical Sketch,” in Boston Medical and Surgical Journal, 196 (1927),1093–1096; Charles S. Sherrington, “Lister’s Contributions to Physiology,” in Lancet (1927), 1 , 743–744; and “Listerian Oration, 1927,” in Canadian Medical Association Journal, 17 (1927), 1255–1263; J. Tait, “Lister as Physiologist,” in Science, 66 (1927), 267–272; C. J. S. Thompson, “Surgical Instruments Designed by Lord Lister,” in Boston Medical and Surgical Journal, 196 (1927), 946–951; and A. Young, “Lord Lister’s Life and work,” in Janus, 31 (1927), 318–335. Among articles in foereign journals commemorating Lister’s centenary are J. P. zum Busch, “Zur Erinnerung an Joseph Lister,” in Deutsche medizinische Wochenshrift, 53 (1927), 583–585; A. Eiselberg, “Zu Josef Lister’s 100. Geburtsrage,” in Wiener klinische Wochenschrift, 40 (1927), 461–465; B. F., “Le Centenaire de Lister,” in Presse médicale, 35 (1927), 523–524; and M. von Gruber, “Lord Lister and Deutschland,” in Münchener medizinische Wochenshrift, 74 (1927), 592–593.
Other biographical accounts and articles on miscellaneous aspects of Lister’s life and work, mostly published after 1927, include: E. Archibald, “The Mind and Character of Lister,” in Canadian Medical Journal, 35 (1936), 475–490, fifth Listerian oration; C. Ballance, “Lister and His Time,” in Lancet (1933), 1 , 815–816; H. C. Cameron, “Lord Lister and the Catgut Ligature,” in British Medical Journal (1912), 1 , 579 (correspondence); Johnson and Johnson, Lister and the Ligature. A Landmark in the History of Modern Surgery (New Brunswick, N. J., 1925); C. Martin, “Lister’s Early Bacteriological Researches and Origin of His Antiseptic System,” in Medical Journal of Australia (1931), 2 , 437–444, the Listerrian oration; Lord Moynihan, “Lister—the Idealist,” in Canadian Medical Association Journal, 23 (1930), 479–488, the third Listerian pration; R. Muir, “The Fourth Listerian Oration,” ibid., 29 (1933), 349–360; J. Riera, “The Dissemination of Lister’s Teaching in Spain,” in Medical History, 13 (1969), 123–153; I. M. Thompson, “Lister’s Early Scientific Background,” in Manitoba Medical Review, 20 (1940), 95–100; I. Veith, “Lord Lister and the Antivivisections,” in Modern Medicine of Canada, 16 (1961), 43–57; and A. O. Whipple, “A Consideration of Recent Advances in Medical Science in the Light of Lord Lister’s Studies,” in Canadian Medical Association Journal, 41 (1939), 323–331, the sixth Listerian oration.
Writings that provide background and perspective to Listerian doctrines and methods are J. P. Arcieri, “Enrico Bottini and Joseph Lister in the Method of Antisepsis. Pioneers of Antiseptic Era,” in Alcmaeon, 1 (1939), 2–13, repr. by Istituto di Storia della Medicina dell’Università di Roma (Rome, 1967); E. Bottini, “Dell’acido fenico nella chirurgia pratica e nella tassidermica,” in Annali universali di medicina,198 (1866), 585–636; A. K. Bowman, The Life and Teaching of Sir William Macewen (London, 1942); J. Burdon-Sanderia “The Origin and Distribution of Microzymes (Bacteria) in Water, and the Circumstances Which Determine Their Existence in the Tissues and Liquids of the Living Body,” in Quarterly Journal of Microscopical Science, n.s. 11 (1871), 323–352; W. W. cheyne Antiseptic Surgery (London, 1882); D. J. Ferguson, “Paréian and Listerian Slants on Infections in Wounds,” in Perspectives in Biology and Medicine,14 (1970), 63–68; S. Gamgee, “The Present State of Surgery in Paris,” in Lancet (1867), 2, 392–393, 483–484; T. W. Jones, Report on the State of the Blood and the Blood Vessels in Inflammation (London, 1891); T. Keith, “Fiftyone Cases of Ovariotomy,” in Lancet (1867), 2 , 290–291; and “Second Series of Fifty Case of Ovariotomy…,” ibid. (1870), 2 , 249–251; J.Lemaire, De l’acide phénique (Paris, 1863); J. Lucas-Championnière, Chirugie antiseptique (Paris, 1876), of which the 2nd ed., trans. by F. H. Gerrish, appeared as Antiseptic Surgery. The Principles, Modes of Application and Results of the Lister Dressing (Portland, Me., 1881); W. MacCormac, Antiseptic Surgery (London,1880); V. Manninger, Der Entwicklungsgag der Atisptik und Aseptik (Breslau, 1904); L.Munster, “Einvergessener Vorkämpfer der Parasitenlehre: Agostino Bassiaus Lodi…,” in Janus, 37 (1933), 221–246; J. N. Ritter von Nussbaum, Leitfaden zur antiseptischen Wundbehandlung insbesonder zur Lister’schen Methode (Stuttgart, 1881); L. Pasteur, “Recherches sur la putréfaction,” in Comptes rendus hebdomadaires des seances de l’Académie des sciences,56 (1863), 1189–1194; and related papers in Oeunres de Pasteur, II (Paris, 1922); A.Sabatier, Des méthodes atiseques chez les anciens et chez les modernes (Paris, 1883); C. Schimmelbusch, Anleitung zur aseptischen Wundbehandlung (Berlin, 1892), trans. by F. J. Thornbury as A Guide to the Aseptic Treatment of Wounds (New York, 1895); T. Spencer Wells, “Some Causes of Excessive Mortality After Surgical Operstions,” in British Medical Journal (1864),2 , 384–388; J. Tyndall, “On Dust and Disease,” in Fragments of Science (London, 1871); and Essays on the Floating-Matter of the Air, in Relation to Putrefaction and Infection (London, 1881); and B. A. G. Veraart, “Semmelweis and Lister,” in Nederlandsch Tijdschrift voor Geneeskunde, 74 (1930), 1762–1775.
Skeptical or critical articles include those of P.Bruns, “Fort mit dem Spray!,” in Berliner klinische Wochenschrift,17 (1180), 609–611; the editorials “Antiseptic Surgery,” in Lancet (1875), 2 , 565–566, 597–598; and “The Debate on Antiseptic Surgery,” ibid., 744–747; J. Y. Simpson, “Carbolic Acid and Its Compounds in Surgery,” ibid., 546–549; the editorial “Professor Lster,” ibid. (1877), 1, 361; and letters to the editor by T. Bryant, “Professor Lister and Clinical Surgery in the London Hospitals,” ibid. (1877), 1 , 367–368; W. A. Leslie, ibid., 368; and T. Smith, ibid., with Lister’ reply appearing as “Clinical Surgery in London and Edinburgh,” ibid., 475–477.
Biographies of Lister are J. R. Bradford, in Dictionary of National Biography (1912–1921 supp.), pp. 339–343; Hector C.Cameron, Joseph Lister the Friend of Man (London, 1949); W. Watson Cheyne, Lister and His Achievement (London, 1925); J. D. Cromie, History of Scottish Medicine (London, 1932), II, 597–600, 635–639, 669–671; Cuthbert Dukes, Lord Lister (London, 1924); Rickman J. Godlee, Lord Lister (London, 1917); D. Guthrie, Lord Lister, His Life and Doctrine (Edinburgh, 1949); J. R. Leeson, Lister as I knew Him (New York, 1927); A. E. Maylard, J. A. Morris, and L. W. G. Malcolm, Lister and the Memoirs (New York, 1980), pp. 100–113; J. Pagel and W. Haberling, “Lister, Lord Joseph,” in Biographisches Lexikon der hervorragender Aeerzte, III (Berlin-Vienna, 1929–1935), 803–805; H. Sigerist, “Joseph Lister (1827–1912),” in Grosse Ärzte (Munich, 1932), pp. 277–280; St. Clair Thomson, “Joseph Lister (1827–1912), the Founder of Modern Surgery,” in D’Arcy Power, ed., British Masters of Medicine (London, 1936), ch. XVII, pp. 137–147; R. Truax, Joseph Lister, Father of Modern Surgery (London, 1947); A. L. Turner, ed., Joseph, Baron Lister, Ceentenary Volume 1827–1927 (Edinburgh-London, 1927); Kemmeth Walker, Joseph Lister (London, 1956); M. E. M. Walker, “Lord Lister, O.M., F.R.S., 1st Baron of Lyme Regis, 1827–1912,” in Pioneers of Public Health (Edinburgh, 1930), pp. 154–165; and G. T. Wremch, Lord Lister, His Life and Work (London, 1913).
Claude E. Dolman
Joseph Lister (1827–1912) was an English surgeon. Educated at University College, London, he practiced and taught surgery in Scotland, first in Glasgow and then in Edinburgh, before returning to London in 1877. Lister was concerned about the frequently fatal wound infections that followed surgical operations, and, in search of solutions to this problem, he studied the work of European bacteriologists, notably that of Louis Pasteur. Lister thought that bacteria caused the postoperative infections that were so common, and although the connection between bacteria and infection had not been confirmed beyond doubt at that time, he understood that bacteria could be killed by antiseptics. He came up with the idea of using carbolic acid for this purpose and started the practice of preoperative cleansing of his and his assistants' hands with carbolic acid, as well as spraying carbolic acid liberally in the air in the operating room. The dramatic beneficial results of what amounted to an experimental trial of this regimen were reported in the Lancet in 1867. Lister's methods transformed the practice of surgery from a desperate, life-threatening gamble into a relatively safe procedure for many conditions—including the management of childbirth.
Unlike Ignaz Semmelweiss and Oliver Wendell Holmes, who preceded Lister in recognizing the importance of cleanliness in preventing infection during childbirth, Lister offered a method that did not imply that doctors were dirty, and so his message was heeded rather than rejected. Therefore he, more than Semmelweiss or Holmes, deserves much credit for making childbirth safe, as well as for the concept of antiseptic surgical operations. Lister was showered with honors, including elevation to the peerage, the first medical doctor to achieve this distinction. He was buried in Westminster Abbey with the pomp and ceremony reserved for the greatest national heroes.
John M. Last
(see also: Antisepsis and Sterilization; Holmes, Oliver Wendell; Semmelweiss, Ignaz )
Lister, J. (1867). "On a New Method of Treating Compound Fractures, Abscesses, Etc., with Observations on the Conditions of Suppuration." Lancet 1:326–329, 357–359, 387–389, 507–509; 2:95–96.
—— (1867). "On the Antiseptic Principle in the Practice of Surgery." Lancet 2:353–356, 668–669.
LISTER, JOSEPH (1827–1912), English surgeon and scientist.
Joseph Lister was born on 5 April 1827 in the village of Upton, Essex. His father, a Quaker and fellow of the Royal Society, encouraged Lister's early interest in microscopy. In 1844 he attended University College, London. Although he joined the college's arts faculty, Lister maintained his scientific interests and, after a break to recuperate from a bout of smallpox, he entered University College Medical School in 1847. The school was unique among English medical schools in its emphasis on experimental science as the basis of good medical practice. This view informed much of Lister's subsequent career.
Lister graduated in 1851 and took a post as junior surgeon in the Royal Infirmary, Edinburgh. He continued his research under the patronage of James Syme, professor of clinical surgery, and in 1860 married Syme's daughter Agnes. In the same year Lister moved to Glasgow to take up the chair of surgery. Here he began to consider the complex problem of surgical sepsis.
At this time patients undergoing hospital surgery suffered high death rates: estimates range from 10 to 45 percent. Postoperative wound infection—the "hospital diseases" such as gangrene and erysipelas—caused most of these deaths. Many of the leading figures in the Victorian public health reform movement—such as Edwin Chadwick, author of the influential Report on the Sanitary Condition of the Labouring Population (1842)—blamed high mortality rates on the size and location of the hospitals themselves. Their solution was to break up the large city hospitals and replace them with smaller rural institutions. The challenge facing Lister and his colleagues was not merely to solve the problem of surgical sepsis, but to do it in a way that could vindicate both experimental medicine and hospital surgery.
Lister took as his inspirations the germ theory of disease developed by Louis Pasteur (1822–1895) and the prevailing notion that inflammation and suppuration were a necessary part of wound healing. He sought a technique that would allow the body to heal naturally through the production of "laudable pus," while keeping out airborne contaminants that he thought would lead to critical infection. In a short paper in the Lancet in March 1867 Lister advocated the use of carbolic acid, applied to wound dressings, as a means of preventing sepsis and described eleven cases of compound fracture that he had treated successfully with this method.
The medical profession's response to Lister's "antiseptic" method was mixed. Some older surgeons opposed the encroachment of science on the "craft" of surgery, and others argued that carbolic was unnecessary. However, his technique was widely discussed and, by 1870, widely used. Lister continually modified his method: in 1870 he introduced a steam-powered carbolic spray for use during operations. His other innovations included a lighter, more flexible gauze dressing, rubber tubes that could be inserted into wounds to drain away pus, and (perhaps his most enduring innovation) the dissolvable suture.
Lister's return to London in 1877 as professor of surgery at King's College provided an opportunity to change the theoretical basis of antisepsis, as Pasteur's germ theory was replaced by that of the German bacteriologist Robert Koch (1843–1910). After Koch showed that skin-borne rather than airborne pathogens were the major cause of infection, Lister's carbolic spray (unpopular also because it drenched surgeons in warm acid) became obsolete. Also discarded was the idea of "laudable pus": Koch had shown that all suppuration represented infection. From the early 1880s German surgeons had begun to combine Koch's and Lister's observations, using soap to clean their hands and high-pressure steam to sterilize instruments and garments. This "aseptic" method was taken up in Britain, where by 1900 it had replaced "Listerism" as the preferred method of preventing sepsis. Lister retired from King's College in 1893 and moved to Walmer, Kent, where he died on 10 February 1912. He had no children.
Lister's impact on surgical practice must be separated from public perceptions of his work. Even in his lifetime Lister was hailed as the "father of modern surgery": in 1883 he received a baronetcy and in 1897 a peerage (the first British clinician to be so honored). His early biographers credited him with both the antiseptic and the aseptic methods, and also with significant contributions to modern germ theory. Twenty-first-century historians—notably Christopher Lawrence—have challenged this view and sought to contextualize Lister's work in Victorian
culture. Lister exemplified the Victorian "Great Man": a faithful husband, committed to working for the public good, he was revered by politicians and journalists. By helping to change the public image of surgery from a bloody craft to a clinical science, Lister greatly improved the standing of the surgical profession within society. This earned Lister the respect and support of his colleagues, whatever their views on the validity of his theories or his actual contribution to their practice.
Lister, Joseph. "On a New Method of Treating Compound Fractures, Abscesses, etc., with Observations on the Condition of Suppuration." Lancet 89 (1867): 326–329.
Gaw, Jerry L. "A Time to Heal": The Diffusion of Listerism in Victorian Britain. Philadelphia, 1999. Penetrating analysis of the sociopolitical context of Lister's work.
Granshaw, Lindsay. "'Upon This Principle I Have Based a Practice': The Development and Reception of Antisepsis in Britain, 1867–90." In Medical Innovations in Historical Perspective, edited by John Pickstone, 17–46. London, 1992. Excellent summary of current scholarship on Lister and Listerism.
Lawrence, Christopher, and Richard Dixey. "Practising on Principle: Joseph Lister and the Germ Theories of Disease." In Medical Theory, Surgical Practice: Studies in the History of Surgery, edited by Christopher Lawrence, 153–215. London, 1992. Superb deconstruction of the "Lister Myth."
Born: April 5, 1827
Died: February 10, 1912
The English surgeon (doctor who performs operations) Joseph Lister discovered the antiseptic method, in which a germ-killing substance is applied to wounds during an operation. This represented the beginning of modern surgery (an operation to correct a disease or condition).
Joseph Lister was born in Upton, Essex, England, on April 5, 1827, the fourth of Joseph Jackson Lister and Isabella Harris Lister's seven children. His father was a wealthy wine merchant and student of Latin and mathematics who also developed an achromatic (possessing no color) lens for the microscope. As a child Lister studied fish and small animals. He also did microscopic research, and his later acceptance of Louis Pasteur's (1822–1895) work may be related to his understanding of the process of fermentation (the chemical breakdown of a compound) in relation to the making of wine.
Lister knew at a young age that he wanted to be a surgeon, but his father made sure he completed his formal education first, just in case. As a teenager Lister attended schools at Hitchin and Tottenham, England, studying mathematics, natural science, and languages. In 1844 he entered University College in London, England, to study medicine. After graduating in 1852, he began a surgical career in Edinburgh, Scotland. In 1860 he became professor of surgery at the Royal Infirmary in Glasgow, Scotland.
Making surgery safer
With the introduction of anesthesia (something that causes a patient to lose sensation in a certain area of the body or the entire body) in the 1840s, operations had become more common. Except, many patients died from infection following surgery. Inflammation (swelling) and suppuration (pus formation) occurred in almost all accidental wounds after surgery, and more so when patients were treated at the hospital rather than at home by a visiting surgeon. The reason was unknown, but it was believed to be something in the air. As a result wounds were heavily dressed or washed with water to keep the air out; operations were a last resort. The head, chest, and stomach were almost never opened, and injured limbs were usually amputated (cut off).
Lister's research centered on the microscopic changes in tissue that result in inflammation. When he read Pasteur's work on germs in 1864, Lister immediately applied Pasteur's thinking to the problem he was investigating. He concluded that inflammation was the result of germs entering and developing in the wound. Since Pasteur's solution of killing germs with heat could not be applied to the living body, Lister decided to try a chemical to destroy the germs.
That same year Lister read in the newspaper that the treatment of sewage (liquid waste matter from sewers) with a chemical called carbolic acid had led to a reduction of diseases among the people of Carlisle, England, and among the cattle grazing on sewage-treated fields. In 1865 he developed a successful method of applying carbolic acid to wounds. The technique of spraying the air in the operating room with carbolic acid was used only briefly, as it was recognized that germs in the air were not the main problem. Lister perfected the details of the antiseptic method and continued his research. He developed the surgical use of a sterile (germ-free) thread for closing wounds and introduced gauze dressings. Antisepsis became a basic principle for the development of surgery. Amputations became less frequent, as did death from infections. Now new operations could be planned and executed safely.
In 1869 Lister returned to Edinburgh, and in 1877 he was appointed professor of surgery at King's College in London, England. He won worldwide acclaim, honors, and honorary (received without fulfilling the usual requirements) doctorates and was made a baron in 1897. After he retired from medicine in 1893 he became foreign secretary of the Royal Society (Great Britain's oldest organization of scientists), and he was its president from 1895 to 1900. He died at Walmer, Kent, England, on February 10, 1912. Although Lister's antiseptic method was soon replaced by the use of asepsis (keeping the site of the operation and the instruments used free from germs), his work represented the first successful application of Pasteur's theory to surgery and marked the beginning of a new era.
For More Information
The Collected Papers of Joseph Baron Lister. 2 vols. Birmingham, AL: Classics of Medicine Library, 1979.
Cartwright, Frederick F. Joseph Lister: The Man Who Made Surgery Safe. London: Weidenfeld & Nicolson, 1963.
Fisher, Richard B. Joseph Lister, 1827–1912. New York: Stein and Day, 1977.
McTavish, Douglas. Joseph Lister. New York: Bookwright Press, 1992.
Lister, Joseph (1827-1912)
Lister, Joseph (1827-1912)
Joseph Lister contributed to a fundamental revolution in surgery with the introduction of his antiseptic method. At the time Lister was practicing medicine, the mortality rate for certain injuries and surgeries was extremely high due to infection. The mortality rate dropped drastically with the use of an antiseptic method, and when used in conjunction with the anesthetics that were available at the time, surgeons dared to perform more complicated surgical procedures.
Lister was born to a well-known Quaker family at Upton, England. Lister studied medicine at University College, and received his medical degree in 1852. As a student, Lister had the opportunity to be a spectator at the first surgery performed with general anesthesia, performed by Robert Liston (1794–1847). He also studied histology under William Sharpey during which time, Lister wrote an important paper on inflammation where he discussed the susceptibility to disease of inflamed tissue. Lister was also interested in microscopic anatomy and physiology, perhaps because his father, Joseph Jackson Lister, was a microscopist. At one point, Lister wanted to become a surgeon and left England to study at Edinburgh University with James Syme (1799–1870), who was well known for his success with performing amputations and joint excisions. Syme, the first surgeon to adopt antisepsis and anesthesia, eventually became Lister's father-in-law.
As a surgeon, Lister was concerned with the high mortality rate of post-amputation patients and the high rate of gangrene after surgery. Applying the knowledge that bacteria caused disease, and drawing from Louis Pasteur's work that proved the existence of airborne microorganisms , Lister concluded that airborne bacteria could cause infection in surgical wounds. Lister read about the affect of carbolic acid used on sewage bacteria in outhouses, cesspools, and stables in the nearby town of Carlisle, and developed an antiseptic system whereby he would spray carbolic acid in the operating room, and use it to sterilize the surgical instruments and his hands. In addition, he applied the acid in and around the wound, and directly on the dressings. Lister first used this method in 1865 while treating a compound fracture of a leg, an injury that often claimed about 60% of patients, and where amputation of a limb was usually the only treatment. The procedure was successful. Lister published his antiseptic method in The Lancet, in 1867. There was one problem: carbolic acid, especially the spray, was harmful to those who came in contact with it. However, Lister found milder antiseptics and later heat-sterilized the surgical instruments. At first, the medical community did not support Lister's theory, but eventually his antiseptic method gained recognition and was adopted as standard procedure for treating wounds and during surgery. Medics used Lister's antiseptic method, which proved to be effective, during the Franco-Prussian War (1870–1871). In 1877, Lister became Professor of Surgery at King's College, London.
Lister received many honors and awards. A dedicated surgeon, he treated both inflicted and surgical wounds; he experimented with various antiseptics, developed absorbable sutures, and introduced a method of draining wounds. He was the first British surgeon to be elevated to the peerage (became a member of the House of Lords), and upon his death in 1912, his remains were interred in Westminster Abbey. When he died, it was said that Lister had saved more lives than all the wars in history had claimed.
See also Bacteria and bacterial infection; History of microbiology; History of public health; Infection and resistance; Infection control
Joseph Lister is known as the founder of antiseptic surgery, a significant advance in medicine developed in the nineteenth century. Infection of wounds and surgical incisions was a major cause of hospital deaths before Lister developed a way of preventing these infections with chemical antiseptics. His discovery made surgery much safer and permitted surgeons to perform operations not previously attempted because of the high risk of fatal infections.
Lister attended University College in London, England, for both his undergraduate and medical education, graduating with honors in 1852. His first position following graduation was as a staff surgeon at University College Hospital. In 1854 he accepted an appointment in Edinburgh, Scotland, as an assistant to Dr. James Syme, a prominent surgeon and noted professor of surgery. In 1856 Lister married Dr. Syme's daughter, Agnes, and accepted a position as an assistant surgeon at the Royal Infirmary in Edinburgh. Lister developed a reputation as both a skillful surgeon and excellent teacher. In 1861 he was appointed professor of surgery at the University of Glasgow where he began the experiments that led to the practice of antiseptic surgery.
When Lister became a practicing surgeon in 1852, conditions in surgical wards were truly appalling. Most surgeons operated with unwashed hands and dirty instruments while wearing bloodstained operating coats that were never washed. The patients then rested in beds with dirty linens that were often not even changed between patients. Consequently many patients survived the operation only to die from gangrene or blood poisoning. Nearly all surgical patients experienced infections and the smell of putrefaction permeated surgical wards. The cause of infection was generally attributed to "bad air" and was considered an unavoidable aspect of all hospitals.
In 1864 Lister discussed the possible causes of putrefaction with a chemistry colleague who suggested that Lister read the publications of a French
chemist named Louis Pasteur. Pasteur had demonstrated that both fermentation of liquids and spoilage of butter were caused by "germs" carried in the air, and if these germs were prevented from entering a flask, fermentation and spoilage could be prevented. Lister saw a connection with hospital infections and concluded that it was not air itself that caused infection, but germs carried in the air. Lister reasoned that if hospital germs could be killed, infections could be prevented.
Pasteur had killed germs by boiling, a technique which could not be used on patients, but chemicals that killed germs could be applied to wounds, instruments, the surgeon's hands, and to bandages. Carbolic acid, now called phenol , was already known as a deodorizing agent and preservative, and Lister thought it might kill the germs that were causing infections. In 1865 Lister began using carbolic acid as an antiseptic during surgery and in bandaging afterward, publishing his results in 1867.
Initially his procedures were met with scorn and the idea that invisible germs were the cause of hospital infections was widely ridiculed. As his students and visitors witnessed antiseptic surgery's great success in reducing deaths from hospital infections, however, Lister's procedures became accepted. Within a few years Lister was honored in Germany and France, but not yet recognized in London. Following an appointment as professor of clinical surgery at King's College, Lister was able to directly demonstrate the success of his procedures to skeptical London surgeons. In recognition of his contribution to medicine, Lister was made a baronet in 1883 and named Baron Lister in 1897.
Although use of carbolic acid as a germ-killing antiseptic in surgery was later replaced by more effective techniques, Lister became world-renowned for demonstrating the importance of preventing microbial contamination of wounds and surgical incisions.
see also Iodine; Pasteur, Louis.
Robert K. Griffith
Farmer, Laurence (1962). Master Surgeon: A Biography of Joseph Lister. New York: Harper & Brothers.
Fisher, Richard B. (1977). Joseph Lister. New York: Stein and Day.
The English surgeon Joseph Lister, 1st Baron Lister of Lyme Regis (1827-1912), discovered the antiseptic technique, which represents the beginning of modern surgery.
Born in Upton, Essex, on April 5, 1827, Joseph Lister was the son of a wealthy wine merchant who developed an achromatic lens for the microscope. As a student Lister did microscopic research, and his acceptance of Louis Pasteur's work later may be related to his familiarity with the process of fermentation since childhood. After graduating from the University of London in 1852, Lister began a surgical career in Edinburgh; in 1860 he became professor of surgery at the Royal Infirmary in Glasgow.
With the introduction of anesthesia in the 1840s operations had become more frequent, but many patients died from infection following surgery. Inflammation and suppuration (pus formation) occurred in almost all accidental wounds and after surgery, and more so when patients were treated at the hospital rather than at home by a visiting surgeon. The reason was unknown, but it was believed to be something in the air. As a result, wounds were heavily dressed or irrigated with water to keep the air out; operations were a last resort. The body's cavities (head, chest, or abdomen) were practically never opened; injured limbs were usually amputated.
Lister's research centered on the microscopic changes in tissue that result in inflammation. When he read Pasteur's work on germs in 1864, Lister immediately applied Pasteur's thinking to the problem he was investigating. He concluded that inflammation was the result of germs entering and developing in the wound. Since Pasteur's sterilization by heat could not be applied to the living organism, Lister sought a chemical to destroy the germs.
That same year Lister read in the newspaper that the treatment of sewage with crude carbolic acid had led to a reduction of diseases among the people of Carlisle and among the cattle grazing on sewage-treated fields. In 1865 he developed a successful method of applying purified carbolic acid to wounds. The technique of spraying the air in the operating room with carbolic acid was only briefly used, as it was recognized that airborne germs were not of primary importance. Lister perfected the technical details of antisepsis and continued his research. He developed the surgical use of sterile catgut and silk and introduced gauze dressings. Antisepsis became a basic principle for the development of surgery; amputations became infrequent, as did death from infections; and new surgical procedures could be planned and safely executed.
In 1869 Lister returned to Edinburgh, and in 1877 he was appointed professor of surgery at King's College in London. He won worldwide acclaim and honors, including honorary doctorates, a baronetcy in 1882, and a peerage in 1897. After he retired in 1893 he became foreign secretary of the Royal Society and then its president from 1895 to 1900. He died at Walmer, Kent, on Feb. 10, 1912. Although Lister's antiseptic method was soon replaced by the use of asepsis, his work represented the first successful application of Pasteur's theory to surgery and marked the beginning of a new era.
The Collected Papers of Joseph Baron Lister (2 vols., 1909) contains an excellent description and evaluation of Lister's work. The official biography by Lister's nephew, Sir Rickman John Godlee, Lord Lister (1917; 2d ed. 1918), is detailed but dated. Frederick F. Cartwright's popularly written Joseph Lister: The Man Who Made Surgery Safe (1963) gives a well-balanced picture. □
Joseph Lister (1827-1912) developed antiseptic surgery, saving innumerable patients from the dreadful pain and death of post-surgical infection by ensuring that surgical wounds were sterile. Lister was born in Upton, Essex, the son of a London wine merchant. His father invented the achromatic lens, which led to the development of the modern microscope. The senior Lister naturally encouraged his son's interest in microbiology. After receiving his medical degree from University College Hospital in London in 1852, Lister practiced and taught surgery, first in Edinburgh, Scotland, and from 1860, in Glasgow, Scotland.
As a surgeon, Lister became increasingly disturbed by the high rate of often fatal infections that developed in his patients after surgery. A professor of chemistry, Thomas Anderson (1819-1874), drew Lister's attention to the ideas of French chemist and microbiologist Louis Pasteur. After reading some of Pasteur's findings, Lister concluded that the germs described by Pasteur as being carried in the air caused wound infections. As a result, Lister developed a method to destroy these organisms using carbolic acid as an antiseptic.
Lister first used his new antiseptic surgical technique in March 1865. Although this and many subsequent operations proved the effectiveness of Lister's method to prevent infection, Lister's ideas were opposed by many of his fellow physicians, who thought the antiseptic procedures ridiculously complicated and unnecessary.
In 1877 Lister became a professor at London's King's College Hospital, where he continued to promote his antiseptic methods. He also poineered the use of absorbable sutures (stitches) and the introduction of wound drainage. Eventually the medical community was won over by his success. By the late 1870s and 1880s, Lister had gained many honors (including royal titles) and was a greatly respected figure. He died in 1912.
A. S. Hargreaves