Lord Lister Ranks with That of Pasteur by Val- Coagulation
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Book Revi ews Lord Lis te r . By Sir Rickman John Godlee, Bt., his graduation Lister went to Edinburgh for k .c .v .o ., m.s ., f .r .c .s . Ed. 3, revised and reset what was intended to be a short visit to the throughout. Oxford, at the Clarendon Press, clinics of that medical center. There he met Oxford University Press, Humphrey Milford, James Syme, then at the height of his brilliant 1924. career. The acquaintance ripened quickly into The biography of the founder of antiseptic the closest friendship. Lister stayed on to work surgery, by his nephew, Sir Rickman Godlee, with Syme, and in 1855 settled down to prac- has won the great success which was predicted tice in Edinburgh, and began his lectures on for it on its first publication in 1917. The present surgery there. In 1856 he married Syme’s is the third edition and presents but few addi- daughter and was elected assistant surgeon to tions or changes from those which have pre- the Edinburgh Infirmary. While actively engaged ceded it, a statement which should be regarded in clinical surgical work he still found time to as a tribute to the skill, fullness and accuracy work with his microscope and published some with which the work was originally written. papers showing the results of his investigations In English medical literature this biography of into the phenomena of inflammation and blood Lord Lister ranks with that of Pasteur by Val- coagulation. In i860 Lister received the appoint- lery Radot in French, and it is interesting that ment of regius professor of surgery in the two great men whose labors were so closely University of Glasgow, a great honor for so associated in their ultimate results should have young a man. the good fortune to be commemorated by two It was while working at Glasgow that Lister such excellent biographies. As a rule the auto- first became profoundly interested in hospital biographies as well as the biographies of medical diseases and the healing of wounds. Godlee men are sadly disappointing, but Sir Rickman gives some very interesting figures illustrating Godlee has given a dramatic finish to the hard- the difference in the number of operations and working scientific life of the famous Quaker nature of the operative work in hospitals at that surgeon that makes it most thrilling to read time and subsequent to Lister’s great discovery. and presents in startling colors the difficulties Of these the statistics given of St. Bartholo- which he had to overcome in successfully mew’s Hospital are the easiest to draw deduc- establishing his great doctrine. tions from. Joseph Lister came of sturdy Quaker stock. His father, Joseph Jackson Lister, while engaged At St. Bartholomew’s Hospital, probably the in business as a wine merchant, achieved great largest hospital in London at the time, there were, in distinction as a mathematician by his optical 1865, 397 surgical beds. The average annual number investigations, which led to the construction of of operations during the preceding five years was 370, the achromatic lens, one of the most important of which 78 were amputations. The number of adjuncts to modem optical science. Even as a surgical beds at the present time is rather less—390. boy Joseph Lister manifested marked interest In 1912 there were 3561 operations (including 311 in and ability for the study of the natural gynaecological), of which only 25 were amputations. sciences, and at an early age announced his intention to become a surgeon. The univer- As Godlee states abdominal surgery was sities of Oxford and Cambridge being barred to hardly thought of. Practically only one oper- him because of the religious tests which they ation was ever performed on the thorax, the imposed, he entered University College, London, opening of an empyema. The brain and spinal and after receiving his degree of b .a . proceeded cord were practically never operated on except through its medical school, becoming m.b . and a for an occasional trephining of the skull. Fellow of the Royal College of Surgeons in 1852. Amputation was more frequently resorted to Even when a medical student he had found time because attempts at conservative surgery were to do some original research work, publishing so generally disastrous. Erysipelas, pyemia, in 1852 a paper on the muscular structure of septicemia and hospital gangrene were terrible the iris, confirming KoIIeker’s discovery and in enemies that stalked through the surgical addition proving that there are distinct muscles, wards of the best-regulated hospitals and a sphincter and a dilator, and another article marred the work of the best surgeons. Surgeons on the involuntary muscles in the skin. After talked of healing of wounds by “first or second intention,” and of “laudable pus.” Many sub- cut short and the wound tightly closed with stances were known under the name of “anti- comparative safety. This was a tremendous septics” which prevented putrefaction. In 1863 advance in the perfection of the aseptic method. Lemaire published a book extolling the use of It is typical of the nature of the man that up to carbolic acid as a preservative for food and the year of his death he continued his researches anatomical preparations, and also its use in on methods to improve suture material and the surgical dressings. In a second edition, pub- discovery of the absorbable ligature was the lished in 1865, he expresses his belief that putre- result of many years of arduous labor. faction is due to germs. Lemaire’s work was not In 1869 Syme resigned the chair of clinical called to Lister’s attention until 1867 and there- surgery at Edinburgh and Lister was chosen as fore had no influence on his discoveries in anti- his successor. septics. In England many substances, including In spite of the tremendous pressure of a large benzoin, glycerine, iodine and alcohol were used practice and of his teaching duties Lister carried more or less empirically in the dressing of on for many years a most thorough investigation wounds. Drainage for pus was usually supposed into the phenomena of fermentation and putre- to be provided for by the ligatures which were faction. Godlee gives a most interesting account allowed to protrude from the wound, and by of this phase of his activities. It brought him placing the sutures far apart. It is curious but into friendly intercourse with Pasteur, with undoubtedly true that Lister knew absolutely whom he began a correspondence in 1876. nothing of the work of Semmelweiss. The story of the carbolic acid spray, how In 1865 Lister’s attention was aroused by the essential it was at first deemed in the antiseptic work of Pasteur in putrefaction and fermen- method, and how it was finally discarded, the tation and he at once realized the important manner of the introduction of gauze instead of bearing it might have on wound infection and lint or oakum as a dressing and the revival of the suppuration. If putrefaction was due to fer- use of the rubber drainage tube of Chassaignac, mentation, the result of the activities of micro- all are well told and repay the reading. Lister scopic beings borne in the air, the problem lay was led to recommend the rubber tube for in purifying the air, thereby preventing access drainage because of the good result he obtained to the wound of these agents. In other words with it in an axillary abscess which he opened Lister had conceived the idea of asepsis. Unfor- on the person of Queen Victoria. The contro- tunately he himself in his writings used the term versy over Lister’s discovery lasted many years antiseptic as applied to his methods, thereby and raged with great bitterness. His views met giving rise to subsequent cavillings. In 1863 with much opposition among the older members he began a course of earnest experimentation of the profession and were more generally with carbolic acid as the chief agent. His first adopted in the provincial medical centers at an publication on the subject appeared in the earlier date than in London. In Germany Lancet in 1867, with the title “On a New Method Lister’s ideas were much more favorably of Treating Compound Fractures, Abscess, received than they were in England. As early Etc., with Observations on the Conditions of as 1867 Thiersch had adopted the antiseptic Suppuration.” A bitter controversy imme- treatment, and his example was followed by diately began. Sir James Y. Simpson was many other surgeons of note, such as Volkmann especially conspicuous for his opposition to and Stromeyer. Among the French surgeons Lister’s views. He directed attention to Le- Lucas-Championniere was from the beginning maire’s book and insinuated that Lister had an ardent disciple of Lister. He had visited stolen his ideas from that source. However, Glasgow in 1869 and saw Lister himself per- many surgeons journeyed to Glasgow and on forming operations and dressing cases anti- seeing the results obtained by Lister in his wards septically, and in 1876 he published the first became convinced of the value of his method. authoritative book on antiseptic surgery. In Lister’s next advance was to try and eliminate both the French and German armies in the War the necessity for bringing the ends of ligatures of 1870 there were some efforts by a few of the out through the wound. He did not have much surgeons to apply antiseptic methods to the success with silk ligatures but on changing to management of wounds. Lister published a catgut he found that the ligature ends could be short article entitled “A Method of Antiseptic Treatment Applicable to Wounded Soldiers in the Present War,” describing the simplest method he could devise to use carbolic acid as an antiseptic.