"The Father Of Modern Surgery"
The hospital environment has not always been a place of sterility and extreme cleanliness that is associated with it so readily today. Prior to the work of Joseph Lister, the hospital was a place to go to die, not to be cured. If an individual was able to survive the pain and torture of surgery without anesthesia, a postoperative infection would most certainly be their ultimate demise. Thanks to Joseph Lister, later known as Baron Lister, a hospital is now a place of healing and cleanliness, not one of death and filth.
Table of Contents:
Lister's Early Life
Contributors to Lister's work
Resources and Additional Readings
Lister's Early Life:
Joseph Lister was born to Joseph Jackson Lister and Isabella Harris on April 5, 1827 in Upton, England. Upton was a small village outside of the reaches of ever-growing London. Joseph's family were members of the Society of Friends and therefore he was raised in a Quaker environment. Joseph's father, Joseph Jackson Lister was also a well-known scientist known for his invention of the achromatic microscope in 1830, allowing for rapid progress in the studies of cells, bacteria and disease. (Meadows, 180).
Joseph had a happy childhood with his four siblings and was a good student. He had particular interests in the fields of botany and zoology. Joseph was able to enter the University College of London in 1844. This was important because at the time entrance to the universities in England were restricted to those who would pledge an oath to the king and the church of England. Pledging such an oath was directly against the religious beliefs of the Quakers. The University College of England was a nonsectarian school and the Quakers were able to attend it. Joseph Lister received his college degree in 1847 at the age of 20. Lister was not satisfied in only memorizing medical facts, for he was aware of the problems that can pursue. For example, for hundreds of years physicians trusted the work of Galen only to realize that his work was based on animal physiology not human. Lister realized the importance of the work of his ancestors, but was appalled at the fact that outdated material could be learned for hundreds of years.
Lister was lucky to be entering medical school in a time when many important changes were taking place. Medical students were now allowed to dissect human bodies, previously thought to have been grounds for execution and certainly morally apprehensible. The methods by which students learned were also modernized, and the public view of surgeons was being changed. As late as the early to mid-1800's surgeons were not considered worthy of the respect of physicians, and were not permitted by law to practice medicine. As the technology surrounding surgery was enhanced, the surgeons began to gain respect in their own right. The use of ether in surgery as an anesthetic allowed the surgeons to concentrate more on detail and less on speed. Prior to ether, the surgeon's speed was the only way to minimize the pain of the patient. Lister was a very sympathetic person, and strove early in his career to change the previously accepted conceptions of surgery. When Lister began his education surgery had a mortality rate of over 50%. This was accepted by society, but not by Lister. He set out very early to change this problem.
Joseph continued his education and questioned many aspects of the traditions that had begun to surround surgery. After some time as a resident at University Hospital in London, Joseph is offered a chance to visit Mr. James Syme in Edinburgh, Scotland. Joseph is timid about working with Mr. Syme with his renown temper, but takes the position in Scotland. Syme took a liking to Lister and they had not only a working relationship, but Lister married Syme's daughter Agnes in April 1865. Agnes served to be not only Joseph's wife, but also an important aide in his research. After a four month travel throughout Europe visiting medical men and facilities, the couple settled down and Lister continued his work in Edinburgh.
Following his return from his honeymoon trip throughout Europe, Joseph continued his work in Edinburgh, but with the help of his new bride was able to begin research as well. His first question concerned that of the coagulation of blood. He was able to collect much information which helped him in his following research of inflammation. Lister was aware that inflammation was the first stage to many postoperative conditions, and although many theories existed, almost all of them were devoid of real facts. In June of 1857, An Essay on the Early Stages of Inflammation, was read and then later published. Lister studied varying effects of irritation on the skin and the resulting inflammation. His conclusion was that "the tissues of the affected parts have experienced to a proportionate extent a temporary impairment of functional activity or vital energy." (Truax, 54).
In January 1860, Joseph and Agnes moved to Glasgow where he was appointed Regius Professor at the university there. Lister was met by extreme filth and unfavorable conditions in his wards in Glasgow, and lack of cooperation from his colleagues in keeping the area clean. Lister had noticed in Edinburgh that keeping the area clean seemed to decrease the risk of infection, although he had no answer for why this made a difference.
"Hospitalism", as the diseases septicemia, erysipelas, and pyemia began to collectively be known was the root of the overwhelming mortality rate in the hospital setting (Weber, 337). Joseph Lister was aware of this, and he studied the works of other prominent scientists to learn that the infections were not caused by a chemical reaction, or an oxidation, that occurred when oxygen touched the wound, but by tiny organisms from the air.
The problem that vexed Lister the most was that of sepsis following compound fractures, a fracture in which the skin is broken and the bone exposed. Such a malady required surgery and had an extremely high mortality rate, especially when the individual remained in the hospital following the surgery. After learning of Louis Pasteur's work and doing his own experiments Lister knew that he needed to keep the wound free of the microbes that were causing the infections. Joseph Lister had heard of Carbolic Acid being used to remove the odors from sewage and decided to try to use it on a small boy with a compound fracture of his leg. The wound did not suppurate following surgery and the only injury was that the acid was burning the boys skin. Lister explains the case and the following ones in which he perfects his method in his essay "On a New Method of Treating Compound Fracture, Abscess, Etc.". Lister also discusses his removal of abscesses, a surgery considered an unnecessary risk during those days. Lister's survival rate was astonishing and other surgeons and professionals began to pay notice.
After the death of James Syme, Lister returned to Edinburgh as the Chair of Clinical Surgery. Here Lister was able to spend more time teaching as well as furthering his research. Lister was not always met with complete acceptance and had to train his colleagues as well as the nursing staff in Edinburgh to his new methods. The nursing profession was improving a great deal at this time with the work of Florence Nightingale and her schools, however the surgeons and other physicians were set in their ways. They saw Lister's excessive cleanliness and particularly his carbolic acid sprays during surgery as a waste of time and effort. The spray burnt their hands and eyes, and cleaning tools and linens a wasted effort.
Lister did not only continue to change and experiment with new methods of asepsis, but had other influences as well. After treating Queen Victoria successfully she began to ask for his aid in ending animal experimentation, particularly vivisection. Joseph Lister could not entirely denounce the importance of such experiments, however he did write letters in defense of fair treatment of laboratory animals. Lister also continued to travel throughout Europe and the United States teaching his methods as well as learning from many other significant scientists. However his success was not so great on the home front, and his lack of acceptance in London greatly disturbed him. In 1877, he and his wife moved to London where he was Chair of Surgery at King's College for the next 16 years. At first Lister was met with skepticism and then disbelief, however he did not give up and attempted an unheard of event. Lister opened a man's knee in order to repair a fractured patella, an absurd risk according to his peers. This surgery became a signature for Lister and he exhibited six successful cases in 1883 at the London Medical Society, the same year he was knighted by Queen Victoria. Lister was finally receiving the well deserved fame for his work.
Throughout the rest of his life Joseph Lister continued to improve his methods of ligatures, bandages and surgery techniques. After his wife's death in 1896 Lister resigned his post in London and closed his practice. He become despondent and disinterested in research, however with the encouragement of his friends he was appointed and accepted a secretaryship of the Royal Society. Lister enjoyed his communication with other scientists throughout England and the world, and seemed revived. He was active in politics and state matters until his death in 1912 of pneumonia.
Contributors to Lister's work:
Just as with any scientific discovery, a network of scientists working prior to and alongside the credited scientist should be commended for their work. Lister's antiseptic methods were no exception. Lister was fortunate enough to study under some of the most prominent and talented surgeons and scientists of the nineteenth century. As is evident in his writings, Lister was not only educated in surgery, but also in chemistry and biology. While in London during his residency, Lister worked under Professor Thomas Graham, who taught him chemistry, and William Sharpey, the "father of modern physiology." (Traux, 38) As previously discussed, James Syme, his mentor in surgery in Edinburgh, was influential to Lister as well as giving him an arena to experiment some of his ideas.
Lister was not the only person during his time to experiment with cleanliness. Ignaz Philipp Semmelweis, a Hungarian doctor, realized the importance of cleanliness when his mother's who were aided in childbirth by medical students who had previously been working with cadavers had an extreme mortality rate compared to those mothers whom he assisted. However Lister did not learn of Semmelweis's work until much later. If it had not been for the revolution in Hungary which caused Semmelweis to discontinue his research perhaps he would have been credited for discovering that which Lister is known for today. However Joseph Lister did hear about the works of an important Frenchman, Louis Pasteur. Pasteur had disproved the theory of spontaneous generation and implanted in Lister's mind the idea of living ferments. With Pasteur's work in microbiology and Lister's own, Joseph Lister was able to compile enough information to envision the cause of sepsis and it's solution.
Lister died in February of 1912 of pneumonia, the same fateful killer that took his wife. He never wrote any books, so his works are left for us in only a few articles and the accounts from his peers. Joseph Lister was one of the most important surgeons and scientists of the nineteenth century.
Timeline: Here are some important dates in Lister's life, as well as other scientific events.
1827 - April 5, Joseph born
1830 - Oliver Wendell Holmes claimed that the doctor should change their clothes and wash their hands following treatment of a diseased patient before delivering a baby.
1844 - Lister enters the University College of London
1847 - Receives B.A.
1848 - Brother John dies and Lister travels to Ireland to relieve depression; returns home and begins residency at University College Hospital where he studied under Graham and Sharpey
1852 - Receives B.M.; Made a Fellow of the Royal College of Surgeons of England; Moves to Edinburgh to work with Mr. Syme.
1856 - Marries Agnes Syme in April. Begins to study blood coagulation.
1857 - An Essay on the Early Stages of Inflammation
1860 - Appointed Regius Professor of Surgery at the University of Glasglow; Florence Nightengale school of nursing opens in London
1861 - Begins clinical practice along with teaching at the Royal Infirmary. Ignaz Philipp Semmelweis publishes Die Aetiologie.
1864 - Lister applied for the professorship of systematic surgery in Edinburgh and is denied. Learns of Pasteur's work on the germ theory.
1865 - Lister has his first success in treating a compound fracture using carbolic acid; Semmelweis dies from infection due to a small cut.
1867 - Two part series published in the Lancet. "On Compound Fracture" and "Preliminary Notice on Abscess"; Successful removal of breast cancer on sister
1869 - Syme suffers a stroke and resigns position and Lister takes over; Joseph Jackson Lister dies.
1870 - Syme and Simpson die; Franco-Prussian war begins, Lister publishes A Method of Antiseptic Treatment Applicable to Wounded Soldiers in the Present War.
1876 - The Cruelty to Animals Act is passed; attended the International Congress in Philadelphia.
1877 - Appointed Chair of Surgery at King's College in London.
1883 - Lister knighted by Queen Victoria.
1889 - Lister improves the dressing used.
1896 - Agnes Syme Lister dies.
1897 - Lister appointed secretaryship of the Royal Society.
1891 - Formed the British Institute of Preventive Medicine (Later the Lister Institute of Preventive Medicine) and was chairman.
1912 - Joseph Lister dies February 12.
Resources and Additional Reading:
Gerster, MD, Arpad G.The Rules of Aseptic and Antiseptic Surgery.New York:D. Appleton and Company, 1890.
Goldman, Martin.Lister Ward.Bristol:Adam Hilger, 1987.
Lister, Joseph.“On the Antiseptic Principle in the Practice of Surgery.”Nineteenth Century Science:A Selection of Original Texts.Ed. A.S. Weber.Orchard Park, NY:Broadview, 2000.
Metchnikoff, Elie.The Founders of Modern Medicine:Pasteur, Koch, Lister.Freeport, NY:Books for Libraries Press, 1939.
The Research Readers of the Scientific Department.Lister and the Ligature:A Landmark in the History of Modern Surgery.New Brunswick, NJ:Johnson & Johnson, 1925.
Traux, Rhoda.Joseph Lister:Father of Modern Surgery.Indianapolis: Bobbs-Merrill, 1944.
Kandela, Peter. Sketches from the Lancet. The Lancet. London; Mar 13, 1999.
Lister, Joseph.“On a New Method of Treating Compound Fracture, Abscess, Etc.”The Lancet.vol. i, 1867:326,357,387,507, vol. ii, 1867:95.
-------,“On the Antiseptic Principle in the Practice of Surgery.”British Medical Journal.Vol. 2, 1867:246.
-------,“Illustrations of the Antiseptic System of Treatment in Surgery.”The Lancet.Vol. 2, 1867:668.
-------,“An Address on the Antiseptic System of Treatment in Surgery.”British Medical Journal.Vol. 2, 1868:53,101,461,515, vol. 1, 1869: 301.
-------,“Observations on Ligature of Arteries on the Antiseptic System.”The Lancet.Vol. 1, 1869:451.Corrected Feb. 1870.