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Joseph Lister: Pioneer of Antiseptic Surgery
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In 1877, Joseph Lister took up the post as Professor of Clinical Surgery at Kings College London.
He had previously worked in Glasgow and Edinburgh, where he established a worldwide reputation for his "antiseptic" system of surgery. Many people had accepted his ideas, and started using the system for themselves, in this country and abroad – but in London, many surgeons were still sceptical. His nephew Rickman John Godlee recalled:
Lister was now a man with a mission. The antiseptic doctrine had been accepted in every part of the world that counted, except London, where alone it made but little way. The importance of converting the greatest centre of learning and education in England justified almost any sacrifice, and it seemed as if the only way of convincing Londoners were to let them see how he actually carried out the treatment himself, and the results he was able to obtain. (1)
Shortly after his arrival in London, he gave his first lecture. He wanted to make a big impact. He decided to talk about "On the Lactic Fermentation and its bearing on Pathology." But some people in the audience were puzzled. What had fermentation and putrefaction in milk got to do with surgery? But for Lister, it was essential to understand fermentation and putrefaction, to understand his antiseptic system.
He had a lot of "visual aids" with him for the lecture. (Perhaps he looked like the portrait, above.) Here's a description of the event by Sir St Clair Thomson:
The address was delivered from behind a table covered with test tubes, pipettes and flasks, showing tubes and plates of cultures. Not one student had ever seen any such apparatus before; for we must remember that bacteriology was not being taught, for the good reason that it hardly had come into existence.
In the lecture, he talked about his experiments on milk and other materials. In the slide show, you can see some of the objects he used in his experiments - and which he may have referred to in the lecture:
In our Joseph Lister project for schools, we found a number of quotes from lectures by Lister, which explain how some of these objects were used in his experiments. The task, for the students, was to match the descriptions to the objects. For example (in no particular order):
It is not enough that the glasses should be heated; it is necessary that the air which enters them during cooling should be filtered of its dust. This I secure by heating them in a cast-iron box.
If we have a vessel like this liqueur-glass, covered with a pure glass cap, and further covered with a glass shade, and standing on a plate of glass, any organic liquid contained in the liqueur-glass, provided it be free from living organisms at the outset, will remain without any organic development occurring in it, as long as the arrangement of the glasses is left undisturbed.
These covered test-tubes which you see before you, containing boiled milk in their lower part, were inoculated each with a drop calculated to contain one bacterium.
I have watched one and the same organism continuing to grow unmixed in such a glass garden for several weeks together, though carried about with me in a journey made in an autumn holiday.
The liquid is introduced to a flask with a bent spout. The liquid, if it was pure to start with, will remain ready to be used again a month or even a year later if required.
One other piece of apparatus requires a short notice, viz. that used for withdrawing fluid from the experimental glasses for inoculation or examination. The most convenient means for this purpose I have found to be what may be called a "syringe pipette."
It is now nearly four years since I introduced portions of the same specimen of urine into four glass flasks. I then bent three of the necks at various acute angles, and the fourth was left vertical. The bending of the necks in three of the flasks was with the view of intercepting particles of dust, which, according to the germ theory, are the cause of putrefaction, while the fourth neck was left vertical, to afford opportunity for dust to fall into the liquid. The result was, in the vessel with the upright neck, different kinds of fungi, visible to the naked eye, soon made their appearance; but in the flasks with bent necks, the fluid remains to this day entirely unaltered.
Sources: (1) Rickman John Godlee, Lord Lister (1918).
Credits:
M0000150: Portrait of Joseph Lister, 1st Baron Lister (1827-1912), surgeon, by Harry Herman Salomon. Attribution 4.0 International (CC BY 4.0). Source: Wellcome Collection. https://wellcomecollection.org/works/dwa5cvad
Lister's "Teaching Charts"
Lister created his own teaching materials and visual aids for the lectures he gave. This included "posters" with "bullet points" for the lecture; and also, long charts - up to 10 metres long - with details of his experiments.
For the Joseph Lister project, we created our own teaching aids, based on Lister's own designs... A "poster" for the lecture at Kings College, and a "chart" showing his experiments on milk.
In the project, we asked the students to think of themselves as a team of people who were preparing a museum on the work of Joseph Lister. We explained that the museum would feature actors working in role as Lister and his assistants. The actors would have to be able to explain Lister's ideas - so we would have to prepare them to be able to do this. Of course, this meant the students first had to examine the materials - the photos, the extracts from Lister's lectures, the poster and the chart - and work out for themselves what it was all about...
Here are two actual posters which Lister produced for his lectures. The first shows his experiments on milk (compared with yeast); the second are points for a lecture on ulcers. Courtesy of the Archive of the Royal College of Surgeons.
LISTER'S DEVELOPMENT OF THE ANTISEPTIC
SYSTEM AT THE GLASGOW ROYAL INFIRMARY
"The last word in hospital construction..."
At the time when Lister began his experiments, the mortality rates following surgery were very high. The real danger often lay, less in the operation itself, than in post-surgical infections which were common in hospitals. This became a source of “grief and mental worry” to Lister, filling him with “a sense of discontent with things as they were” (1), and inspiring his development of a system of antiseptic surgery.
Lister moved to the Glasgow Royal Infirmary in 1860. A new hospital building opened in 1861; it was designed in line with many of the principles for hospital design set down by Florence Nightingale. In his article, “Remarks on the Site and Construction of Hospitals, with Reference to the New Surgical Hospital of the Glasgow Royal Infirmary” (1861), James McGhie wrote approvingly of Nightingale’s work, and claimed:
We may differ from her in opinion on particular points, but we must agree with her in sentiment.
He outlined some of the features of the new building; it possessed “an elevated site, excellent drainage, and an abundant supply of the pure water of Loch Katrine”, and was “widely separated on all sides from the neighbouring buildings”. Indeed, the infirmary’s managers had been determined to make the new building “the last word in hospital construction” (2). There was a special emphasis on ventilation.
"The Glasgow Royal Infirmary should be burned down"
But Nightingale herself was not impressed by McGhie, or the hospital. She wrote:
Dr McGhie’s article betrays either willful misrepresentation or helpless, hopeless, ignorance of his own subject. ... The best that could happen to the Glasgow Infirmary (and what would save much human life) is that it should be burned down. There will be no other safety for it. Almost all its air reaches it over burial ground. Now the mistake has been tripled. But, depend upon it, Dr McGhie knows all this just as well as you or I. (3)
Lister himself said the design of the hospital appeared to be “all that could be desired”: the wards were spacious and lofty, fresh air was “amply supplied by numerous windows at both sides”, and the beds replaced at a considerable distance from each other (4). Nevertheless, the hospital was actually “one of the most unhealthy and insanitary”: the diseases of “hospitalism” such as septicaemia, pyaemia, gangrene, and erysipelas, "were never entirely absent from the wards” (5).
Image: The Lister Ward, c.1900
There were two men’s wards on the ground floor. One of them (Ward 24) was under Lister’s charge, and the other (Ward 23), under the charge of another surgeon. They were separated by just 12 feet. At one point, the mortality rate in Ward 23 was so high that it was closed down temporarily, so the cause could be investigated.
An excavation in 1867 revealed the coffins of cholera victims from the epidemic of 1848-9, buried just a few inches below the surface, in the ground near the wards. A Glasgow newspaper stated:
The Dean of Guild is said to have computed that around the infirmary 5000 bodies in a state of decomposition were lying in pits holding 80 each.
At the time this discovery was made, however, Lister was able to report that in “the previous nine months, during which the antiseptic treatment was carried out completely in his wards, not a case of pyaemia, erysipelas, or hospital gangrene had occurred in them” (5). He put this down to his antiseptic system...
Image: Pasteur
"the whole problem would be solved”
In 1865, Lister was introduced by Dr Thomas Anderson (Professor of Chemistry) to the work of Louis Pasteur. He became convinced that the causes of infection and putrefaction lay in germs carried in the atmosphere; he “saw at once that if they could be destroyed before entering the wound, the whole problem would be solved” (6).
After Lister began to use carbolic acid as an antiseptic agent, the results “were most astonishing” (5). He first used it in March 1865 to treat a compound fracture of the leg; it was not successful, but Lister attributed this to incorrect management of the treatment. Famously, he then applied it in the case of James Greenlees in August 1865.
The boy was 11 years old. He was run over by a cart on the street, and had a compound fracture of the left leg. The treatment “consisted of the direct application of carbolic to the wound, and dressing with lint soaked in carbolic and the covered with tinfoil to prevent evaporation” (7). After six weeks, the boy was discharged, fully recovered.
Sources: (1) James G. Mumford, Surgical Memoirs and Other Essays (1908); (2) James McGhie, “Remarks on the Site and Construction of Hospitals, with Reference to the New Surgical Hospital of the Glasgow Royal Infirmary” (1861); (3) Florence Nightingale and Hospital Reform, Collected Works Vol.16, ed. Lynn McDonald (2012); (4) Joseph Lister, Collected Papers of Joseph, Baron Lister, Vol. 2 (1909); (5) Hector Charles Cameron, Joseph Lister: The Friend of Man (1948); (6) James A. Morris, “The Royal Infirmary Buildings,” in Lister and the Lister Ward (1927); (7) Donald F. Hay, Lister at the Royal (1977).
The Clinic of Dr. Gross
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This is a painting by Thomas Eakins, dated 1875, showing the American surgeon Samuel Gross performing an operation. At that time, operations were often performed to an audience of medical students.
Gross did not believe in Lister's methods. He said:
Little if any faith is placed by any enlightened or experienced surgeon on this side of the Atlantic in the so-called carbolic acid treatment of Professor Lister.
The painting really shows all that was wrong with surgery, prior to Lister's reforms.
Below: students from UCL Institute of Education recreate the Gross portrait at the Old Operating Theatre, London
The Lister Clinic
Here, in contrast, is an image of Lister performing antiseptic surgery (c.1870)...
... recreated by students from UCL
