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A Tribute to Joseph Lister

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A Tribute to Joseph Lister Annals of the Royal College of Surgeons of England (1977) vol 59 150 years after A tribute to Joseph Lister O J A Gilmore MS FRCS FRCSEd Consultant Surgeon, St Bartholomew's Hospital, London Introduction theory of disease. From Pasteur's work Lister The 5th of April I977 marked the Isoth anni- learnt that putrefaction could be prevented versary of the birth of Joseph Lister, Britain's either by the exclusion of germs from the greatest surgeon and the founder of the anti- putrefactive material or by their destruction. septic principle. Modern surgery as we know At the time that Louis Pasteur published it evolved because of the efforts, patience, the results of his elegant experiments wound and determination of this man. infection was still thought to be the direct Joseph Lister was born in i827 at Upton result of the chemical action of oxygen on House, Essex, the fourth child of Joseph Jack- exposed tissues. This resulted in numerous son Lister, a London wine merchant and a and various tight dressings being employed in distinguished microscopist. He qualified at all hospitals in a vain attempt to keep air University College Hospital, London, after from the wound. Despite this, or perhaps which, under the guidance of the physiologist because of it, every ward-in particular every William Sharpey, he studied inflammation, on surgical ward-was faced with the horrors of which subject he addressed the Royal Society 'hospital gangrene'. Few wounds escaped the in I857. Lister had become a Fellow of the effects of this endemic putrefaction. Sir Charles Royal College of Surgeons of England in Illingworth' describes the prevalent conditioins I852, at the age of 25, but later he decided thus: 'The foetid atmosphere of wards, the to move to Edinburgh to study surgery wounds dripping with pus, the convulsions of under Syme, whose eldest daughter, Agnes, lockjaw, the angry fire of erysipelas, the morti- he subsequently married. In I86o at the age fication of hospital gangrene!' Sepsis was such of 33 he was appointed to the Regius chair a problem that it was a bar to the surgical of surgery at Glasgow University and it was treatment of all disease save the gravest. It while in this post that he carried out his was in this atmosphere that Lister established most memorable work. In i 86q Lister re- his antiseptic principle of surgery. turned to Edinburgh to become Professor of Surgery and remained there until I877, when James Greenlees he accepted the chair of surgery at King's It was during the day of I2th August I865 College Hospital, London. He retired from that the boy James Greenlees was hit by a this post at the age of 65 and died 20 years cart and admitted to Glasgow Royal Infirmary later in I9I2, laden with honours. Joseph with a compound fracture of the left tibia. Lister was the first medical man to be el- At that time all compound fractures became evated to the peerage, but his path to accept- infected and many patients died of sepsis. ance and success was by no means straight James Greenlees, however, was more fortunate, or smooth. for within hours Joseph Lister himself had In I865 Thomas Anderson, Professor of dressed the wound with lint soaked in neat Chemistry at Glasgow University, brought carbolic acid before splinting the limb. Every Louis Pasteur's work to the notice of his 4 or 5 days Lister re-dressed the wound in a surgical colleague Joseph Lister. Lister found similar meticulous manner, with the result Pasteur's writing fascinating and, unlike the that both the wound and the fracture healed majority, he immediately accepted the germ without suppuration within 6 weeks. In 200 0 J A Gilmore reporting this and I 0 other cases in the tary surgeons to save lives as well as limbs, Lancet2 Lister stated that he chose carbolic which in the days of Larrey and Guthrie acid for the following reason: would have been severed without hesitation. 'In the course of the year I864 I was much struck- It allowed civilian surgeons to perform opera- wvith an account of the remarkable effects produced tions on regions of the body hitherto untouch- by carbolic acid upon the sewage of the town of able. As a result of the ready acceptance of Carlisle, the admixture of a very small proportion Lister's not only preventing all odour from the lands irri- the antiseptic principle in Germany gated with refuse material, but as is stated destroy- tour through that country in I875 was more ing the entozoa which usually infest cattle fed upon in the nature of a triumphant procession7. such1 pastures. In France Lucas-Champonniere was the 'My attention for several years having been much chief of Listerism. In Italy it directed to the subject of suppuration, more espe- protagonist cially in its relation to decomposition, I saw that was Bassini and in Denmark Professor Sax- such a powerful antiseptic was peculiarly adapted torph. The Americans were relatively slow for experiments with a view to elucidating that in adopting the method, but amongst the early subject, and while I was engaged in the investigation, supporters were Sims and Halstead8. the applicability of carbolic acid for the treatment of compound fracture naturally occurred to me.' Lister initially used crude carbolic acid British scepticism obtained from his colleague Professor Ander- In Britain, particularly London, the doctrine son; this prevented sepsis but, not surprisingly, was received with great scepticism and distrust caused sloughing of the skin2. Later he ob- by the majority of surgeons. Never has the taitied a purer form of carbolic which he mixedl saying 'A prophet is not without honour, save into a paste wvith carbonate of lime and linseed in his own country' (Luke xiii, 57) been so oil. This he reported to a meeting of the applicable. William MacCormac's book9 British Medical Association (BMA) in Dublin reporting a meeting of the South London in a paper entitled 'On the antiseptic prin- Branch of the BMA held at St Thomas's Hos- ciple in the practice of surgery'3. pital in I879 gives great insight into the views In I870 Lister' published further results and feelings of the London surgeons. The meet- on the efficacy of his antiseptic treatment. He ing was held to debate the subject of antiseptic described how his wards in the Glasgow Royal surgery. MacCormac, a surgeon at St Infirmary had been converted from 'some of Thomas's and one of the first believers in the the most unhealthy in the Kingdom into city, opened the meeting by giving an account models of healthiness'. He reported how in of the Listerian method of surgery. He de- the years I864 and i866 (figures for i865 scribed how, after shaving, the patient's skin vere not available) I6 of his 35 amputees was washed with 5/s% carbolic acid and how had died compared with 6 out of 40 in the the operation was performed in a 'carbolized years I867, i868, and I869 following the atmosphere' produced by a jet of steam ming- introduction of this antiseptic method. ling with a 5%/0 carbolic acid solution. All sponges used dturing the operation, having German acceptance been soaked in 5%/, carbolic acid previously, In the same year as these results appeared, were repeatedly rinsed in this same solution because of the Franco-Prussian War (I870- throughout the operation. All instruments _%0 i871), Lister published a small pamphlet were kept in a 2 solution of carbolic and entitled A Method of Antiseptic Treatment bleeding points were secured with carbolized Applicable to Wounded Soldiers in the Present gut or carbolized silk. After closure of the War'. A number of German surgeons, no- wound a silk dressing was applied and over tably von Nussbaum, von Langenbeck, and that carbolized gauze. von Volkmann, used and praised Lister's MacCormac was an advocate of Listerism, methods and continued to use them on return- but in the ensuing debate a number of contrary ing to civilian practice6. Billroth, Mikulicz- views were heard. Mr Bryant called for sta- Radecki, Woffler, and Czerny all adopted the tistical proof. lMr Timothy Holmes stated method in due course, as did Thiersch and that he neither believed in the germ theory Joseph from Leipzig. Listerism enabled mili- of disease nor was convinced of the value of T50 years after 201 FIG. i Joseph Lister FRCS, aged 28 202 0 J A Gilmore ..... ..........- .. .i...,..,-...,.;::.i.;,.",.,.""-.."...,..i;:'..'...:,-:,---::i-`:--,!..'.-':..-i.::i.i;::-,:,:.`-,.-,--,.,'-...,f-:`-,..:: .:-.j.::.'-'-.' ..:::i.."-,:::..-,...,:..":i-.r.'.:.i',.,.;.i.;-,."' t'Q, .,.,;'.-'..f.j..-.,.!.,..,i7.,.-.-ji;:.,:i:: ,::, ,7'.:i':.'i.::::-:.,;.:..-. :, .. .-'..-:.j:.:.:i::::.;.ii.ii.i::'i.:..:.,:.::.:i.:--:-..::-::.- ...-:.:,':.,,:.:,.e::,:-, -.:--,--,.! __.. :!:!i. i..!.-..,: ..........4 ..::": --:... ..i':i:.'.';.;i:.:,.-,:i:.:::.:;:..i..j:.j:':. azin ing abou tire debate, .:i.:.:i.i-,.!.i.i.....,.,.:.,.,....:.... '". ""'111... 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