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Lister, Sir Joseph

Category: Scientist

 

Joseph Lister, 1st Baron Lister, OM PC PRS (5 April 1827 – 10 February 1912), known between 1883 and 1897 as Sir Joseph Lister, Bt., was a British surgeon and a pioneer of antiseptic surgery. 

Widespread introduction of antiseptic surgical methods followed the publishing of Lister's Antiseptic Principle of the Practice of Surgery in 1867. 

Lister also went on to develop new surgical techniques by applying his antiseptic principle. He showed that suitably sterilized materials could be left inside the patient and in 1880, for example, he introduced the use of sterilized catgut for internal stitches, as this would subsequently dissolve. (Previously, silk thread used in internal stitching was left hanging out of the wound and was pulled out later, often causing further damage).  

Lister also introduced the use of rubber drainage tubes after first using one on Queen Victoria and for many years Lister was surgeon to the Queen.  In 1883, Queen Victoria created him a Baronet, of Park Crescent in the Parish of St Marylebone in the County of Middlesex. In 1897 he was further honoured when Her Majesty raised him to the peerage as Baron Lister, of Lyme Regis in the County of Dorset.] In the 1902 Coronation Honours list published on 26 June 1902 (the original day of King Edward VII´s coronation), Lord Lister was appointed a Privy Counsellor and one of the original members of the new Order of Merit (OM). He received the order from the King on 8 August 1902, and was sworn a member of the council at Buckingham Palace on 11 August 1902.

 

In 1881 he was elected President of the Clinical Society of London.  Among foreign honours, he received the Pour le Mérite, one of Prussia's highest orders of merit. In 1889 he was elected as Foreign member of the Royal Swedish Academy of Sciences.

Lister was president of the Royal Society between 1895 and 1900. Following his death, a memorial fund led to the founding of the Lister Medal, seen as the most prestigious prize that could be awarded to a surgeon.

Two postage stamps were issued in September 1965 to honour Lister for his pioneering work in antiseptic surgery.  And a number of buildings have been named in his honour.  In 1903, the British Institute of Preventative Medicine was renamed Lister Institute of Preventive Medicine in his honour. The building, along with another adjacent building, forms what is now the Lister Hospital in Chelsea, which opened in 1985. 

 

A building at Glasgow Royal Infirmary which houses cytopathology, microbiology and pathology departments was named in his honour to recognise his work at the hospital.  Lister Hospital in Stevenage, Hertfordshire, England is also named in his honour.

Lister is one of the two surgeons in the United Kingdom who have the honour of having a public monument in London. Lister's stands in Portland Place; the other surgeon is John Hunter. There is a statue of Lister in Kelvingrove Park, Glasgow, celebrating his links with the city.

He has even had microorganisms named in his honour, including the pathogenic bacterial genus Listeria, as well as the slime mould genus Listerella.

His life achievements

Surgery as a medical discipline faced three great hurdles as it was being introduced. These were the control of bleeding, the control of pain, and the control of infection.

  • Bleeding - In 1552, a leading French doctor, Ambroise Pare, developed and systematized the idea of tying off the ends of broken or cut blood vessels with threads called ligatures in order to minimize bleeding.
  • Pain - The control of pain through anaesthesia was just being introduced during the time when Lister was a university student. Before this, surgery had involved agony for the struggling patient, which in turn meant that doctors had to operate as quickly as possible. The introduction of anaesthetics opened up a new era in surgery, as doctors were now able to take the time necessary to improve their techniques.

The third major hurdle, the control of infection, remained unconquered when Lister began working as a surgeon.

Dr Charles Rlchet Professor Of Physiology In The Faculty Of Medicine Paris 1908
For centuries and centuries surgeons operated without understanding why it was that death struck down so unmercifully those operated upon. In vain did surgeons display great skill ; in vain did the operation succeed : the patient died. Erysipelas, lock-jaw, abscess-formation and gangrene reigned supreme. Every confinement exposed the mother to death ; the slightest wounds were followed by the most serious after-effects ; in certain amputations, for instance, the mortality was 70 per cent.

No one dared to touch either the peritoneum or the joints, because every operation on the peritoneum or on the articulations was sure to prove fatal. But Lister and Pasteur came ! These two men, simultaneously and concurrently, demonstrated that all disease following on an operation was the result of infection by parasites. By preventing the wounds from being contaminated by parasites, infection was prevented; for the wounds themselves are innocent, as long as they are not infected.

This is the astounding and simple truth which Lister and Pasteur established. …..

Thousands and thousands of surgeons, right up to 1868, had understood nothing of infection. In order to understand this big word "infection' which sums up in itself the whole of surgery and the whole of medicine, it was necessary to ….. experiment, … in order to demonstrate that erysipelas is an inoculable disease, that puerperal infection is of the same nature as purulent infection, that all these diseases are due to micro-organisms, and that certain substances, called antiseptics, can stop the development of these fatal germs.

It appears quite natural to-day …… to know that instruments, water, and linen heated to 120 contain no living germs. But this discovery is not so very old.

 

Residents at the Old Royal Infirmary, Edinburgh, summer - Lister is front row seated to left

Before Lister's studies of surgery, most people believed that chemical damage from exposures to bad air was responsible for infections in wounds. Hospital wards were occasionally aired out at midday as a precaution against the spread of infection via miasma, but facilities for washing hands or a patient's wounds were not available. A surgeon was not required to wash his hands before seeing a patient because such practices were not considered necessary to avoid infection.

While he was a professor of surgery at the University of Glasgow, Lister became aware of a paper published by the French chemist, Louis Pasteur, showing that food spoilage could occur under anaerobic conditions if micro-organisms were present. Pasteur suggested three methods to eliminate the micro-organisms responsible: filtration, exposure to heat, or exposure to solution/chemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop antiseptic techniques for wounds. As the first two methods suggested by Pasteur were dangerous and unsafe for the treatment of human tissue, Lister experimented with the third idea.

While still a student, Lister had decided not just to practise medicine, but also to conduct research to improve medical knowledge. His early investigations explored the action of muscles in the skin and the eye, the mechanism involved in the coagulation of blood, and the role played by blood vessels in the early stages of infection. Lister's research required frequent use of a microscope—a tool very familiar to him because of his father's involvement with it.

His research required considerable sacrifice and dedication, as it was undertaken at night after he had completed a full working-day in the hospital wards. Recognition of Lister’s early research came in 1860, when he was made a Fellow of the Royal Society, the same honour that had been bestowed upon his father.

In the Edinburgh Hospital where Lister worked, almost half of the surgery patients died from infection. In some hospitals in Europe, as many as 80 per cent died. While surgeons regretted this high death rate, as Richet mentions above, they trained themselves to accept this unpleasant aspect of their work. Lister however, was not convinced of the inevitability of infection (which was also known as sepsis). He began to search for a way of preventing infection—that is, an antisepsis method.

Joseph Lister: Father of Modern Surgery - Ann Lamont on March 1, 1992 [Creation 14, no 2 (March 1992): 48-51.]

Lister’s first clue as to the cause of infection came from comparing patients who had simple fractures with those who had compound fractures. Simple fractures do not involve an external wound. These patients had their bones set and placed in a cast, and they recovered. Compound fractures are those where the broken bone pierces the skin and is exposed to the air. More than half of these patients died. Lister reasoned that somehow the infection must enter the wound from the outside. But how exactly did this occur? And what could be done to prevent it?

Lister began washing his hands before operating, and wearing clean clothes. …. Even though Lister’s procedures were scoffed at by some of his colleagues, who considered it a status symbol to be covered in blood from previous operations, his talent was becoming recognized. In 1860 he became Professor of Surgery at Glasgow. There, a friend lent him some research papers by the outstanding French chemist, Louis Pasteur. (Like Lister, Pasteur was a committed Christian.)

 

 

As the son of a wine merchant, Lister was all too familiar with the problem of wine going bad because of faulty fermentation. Pasteur had shown that the problem was caused by germs which entered from the air, and Lister immediately recognized the usefulness of Pasteur’s work. If infection arose spontaneously within a wound, it would be virtually impossible to eliminate it. However, if germs entering from the air outside the wound caused infection (in the same way that the wine became contaminated), then those germs could be killed and infection prevented.

Joseph Lister: Father of Modern Surgery - Ann Lamont on March 1, 1992 [Creation 14, no 2 (March 1992): 48-51.]

Pasteur had used heat and filters to eliminate the germs in the wine, but these techniques were not suitable for use with human flesh. Instead, Lister needed to find a suitable chemical to kill the germs. He learned that carbolic acid was being used as an effective disinfectant in sewers and could safely be used on human flesh. Beginning in 1865, Lister used carbolic acid to wash his hands, his instruments, and the bandages used in the operation. Lister also sprayed the air with carbolic acid to kill airborne germs. After more than a year of using and refining these techniques, Lister had sufficient data to show that his methods were a success. He published his findings in the medical journal, The Lancet, in 1867.   Lister was always eager to acknowledge Louis Pasteur’s invaluable contribution. In a letter to Pasteur in February 1874, Lister gave him ‘thanks for having, by your brilliant researches, proved to me the truth of the germ theory. You furnished me with the principle upon which alone the antiseptic system can be carried out.’

 

Two years after publishing his findings, Lister returned to Edinburgh to become Professor of Clinical Surgery—the position formerly held by his eminent father-in-law for more than three decades. Lister introduced his antisepsis procedures in Edinburgh and again met with dramatic success. However, widespread acceptance of Lister’s procedures was rather slow, as is often the case with revolutionary new ideas. Some busy doctors were unwilling to take the time to even consider new ideas. Some found it difficult to believe in germs—living organisms that wrought havoc but were too small to see. Others tried Lister’s procedures, but did so incorrectly and therefore failed to obtain the desired result. (Part of the reason for this was the complexity of Lister’s procedures and the constant modifications he made to his system in order to improve them.) Also, Lister’s method added to the expense involved in dressing wounds.

Joseph Lister: Father of Modern Surgery - Ann Lamont on March 1, 1992 [Creation 14, no 2 (March 1992): 48-51.]

Lister was neither angered nor discouraged by the controversy that raged about his work. Instead, he ‘went on his gentle, unconcerned way saving his patients and trying to cheer them while doing so’. [R. F.Hume, All About Great Men of Medicine]  His compassionate personal involvement with his patients was quite a contrast to the arrogance of those surgeons who believed that such involvement would ‘somehow lessen the holy awe and respect in which patients should hold their doctors’.
Over the next 12 years, Lister’s methods gradually gained acceptance. Doctors from Denmark and Germany were the first to implement Lister’s antiseptic principle, and they met with stunning success. For example, in Munich the death rate from infection after surgery dropped from 80 per cent to almost zero. By 1875, Lister was receiving international acclaim in Europe. However, the majority of English doctors still misunderstood Lister’s work and therefore failed to accept its usefulness. It was not until Lister was appointed Professor of Surgery at King’s College Hospital in London in 1877, that he began to win over the English doctors. By 1879, Lister’s principle of antiseptic surgery had gained almost universal acceptance.

Life

 

Joseph Lister was born in Upton, Essex, England, on April 5, 1827. He was the second of three children born to the Quaker Joseph Jackson Lister, a very successful wine merchant and amateur scientist. Joseph Jackson Lister’s design of a microscope lens which did not distort colours opened the way for the microscope to be used as a serious scientific tool. This contribution to science resulted in Joseph Jackson Lister’s being made a Fellow of the Royal Society—the prestigious British association of experimental scientists.

The Listers were devout Quakers who led a quiet, simple life. Young Joseph attended Quaker schools in Hertfordshire [Benjamin Abbott's Isaac Brown Academy, a Quaker school in Hitchin] and London, where science subjects were emphasized. At school, he also became a fluent reader of French and German, abilities which were to be helpful in his understanding of the work being carried out in these countries. He then went to University College, London, one of only a few institutions which accepted Quakers at that time. He initially studied botany and obtained a Bachelor of Arts degree in 1847.

Shortly after this he contracted smallpox. When he had fully recovered, he returned to the University of London as a medical student, qualifying as a doctor in 1850. Lister obtained Bachelor’s degrees in Medicine and Surgery, and in the process won two university gold medals for his outstanding marks. Further study saw Lister easily pass the examination to become a Fellow of the Royal College of Surgeons (FRCS) in 1852.

In 1853, Lister went to Edinburgh, Scotland, to spend four weeks with Professor James Syme, who was considered to be the greatest teacher of surgery at that time.

 

In 1854, Lister became first assistant to Professor Syme at the University of Edinburgh, Edinburgh Royal Infirmary in Scotland. There he joined the Royal Medical Society and presented two dissertations, in 1855 and 1871, which are still in the possession of the Society today.

Professor Syme had a daughter, Agnes and Syme’s family, along with Agnes were members of the Christian Episcopal church.  Three years later becoming Syme’s assistant, Lister married Agnes and joined her as a member of the Episcopal church. He remained a faithful member of this church for the remainder of his life. Throughout the Listers’ long and happy, but childless, marriage, Agnes was Lister's partner in the laboratory, of great assistance to her husband, helping with experiments and writing up his notes.  Even on their honeymoon, they spent 3 months visiting leading medical institutes (hospitals and universities) in France and Germany.

Final years

 

Lister retired from practice after his wife, who had been his partner, friend and helper in research, died in 1893 in Italy, during one of the few holidays they allowed themselves.

Studying and writing lost appeal for him and he sank into melancholy. Despite suffering a stroke, he still came into the public light from time to time. On 24 August 1902 Edward VII came down with appendicitis two days before his scheduled coronation. Like all internal surgery at the time, the appendectomy needed by the King still posed an extremely high risk of death by post-operational infection, and surgeons did not dare operate without consulting Britain's leading surgical authority. Lister obligingly advised them in the latest antiseptic surgical methods (which they followed to the letter), and the King survived, later telling Lister, "I know that if it had not been for you and your work, I wouldn't be sitting here today."

Lister died on 10 February 1912 at his country home (now known as Coast House in Walmer, Kent at the age of 84. After a funeral service at Westminster Abbey, he was buried at West Hampstead Cemetery, London in a plot to the south-east of central chapel. Both the baronetcy and barony became extinct on his death.

 

Although the materials and procedures used have changed over the years, the antiseptic principle itself remains today as the cornerstone of modern surgery. The importance of Lister’s antiseptic principle is emphasized by the scientist, Dr. Henry Morris

H.M. Morris, Men of Science, Men of God. 1982
This development is probably second only to Pasteur’s contribution to the saving of human lives.

Lister was a committed Christian.

He once wrote: ‘I am a believer in the fundamental doctrines of Christianity’ and it was his faith, his love for his wife and humanity that directed all his work. 

Lister lived his faith.

 

World Book Encyclopedia, 15th edition, 1985, Vol. 7,
Throughout his life, he remained a gentle, shy, unassuming man, firm in his purpose because he humbly believed himself to be directed by God.

And he probably was.