A BIOGRAPHY OF JOSEPH LISTER

BY LAURENCE FARMER, M. D.

Grade Level and Copyright 

Grade Level is 10.8 using the Flesch-Kincaid readability test with three sample chapters.

First edition published by Harper & Row Publishers, 1962.

Electronic edition published by Ebooks for Students, Ltd., 2021.

This ebook is in the public domain, and is free of all copyright restrictions. It is also free of digital rights management protection so you can distribute copies to your students, their parents, and other prospective readers. 

See our other biographies, novels and popular history at ebooksforstudents.org. See our titles on Amazon at https://amzn.to/3brofzU.

Comments  or questions to support@ebooksforstudents.org or (202) 464-9126.

TO THE MEMORY OF ELSE

PREFACE

Near the north transept of Westminster Abbey there is a marble medallion showing the head of a very handsome old man and bearing the simple inscription Lord Lister. It was placed there nearly half a century ago in memory of a great surgeon whose life work will be remembered through the ages. The picture of his great personality is already beginning to fade. To preserve this picture for the present and for future generations of young people is one of the main objectives of this book.

L. F.

AUTHOR’S NOTE

In retelling the story of Joseph Lister, I have leaned heavily upon Sir Rickman Godlee’s excellent biography of his famous uncle. In the preface to his book, lord lister, Godlee tells us that Lister had repeatedly expressed the hope that a biography of him might be a simple record of his contributions to science and surgery. His life work, he apparently believed, would be of interest to posterity, not his person.

Godlee, fortunately, disagreed. Besides presenting an account of Lister’s great scientific achievement, he has given us a first-hand picture of the man. As a close relative and for many years Lister’s private assistant, Godlee was exceptionally well qualified to write of both the man and the scientist. Furthermore, he had access to Lister’s diaries and to the extensive correspondence between Lister and his father and other members of his family. To my knowledge, these documents have not been available to others. Probably they were destroyed to prevent what Lister would have regarded as undesirable prying by strangers into his private life.

I have also utilized Lister’s Collected Papers and taken recourse to the descriptions of him by many of his co-workers. Another important source has been contemporary medical journals, especially the Lancet and the British Medical Journal, from whose faded pages one can still get a vivid picture of the hostility and indifference with which Lister’s teachings were long received. In their perusal one can also relive the extent of Lister’s final triumph.

I am also in the debt of Thomas Clarkson, the famous English fighter against slavery, who has left us, in his Quaker Portraiture, a learned account of Quakerism as it was practiced in the early years of the nineteenth century.

L. F.

ACKNOWLEDGMENTS

The author is indebted to The Clarendon Press, Oxford, England, for permission to reprint material from Sir Rickman Godlee’s lord lister, 3rd edition.

Grateful acknowledgment is also made to Mr. Edward H. Milligan, Librarian, The Friends’ House, London, for making available Thomas Clarkson’s Quaker portraiture; to Mr. Douglas G. F. Walker, Deputy Librarian, University College, London, for procuring a record of the courses taken by Lister at that university; and to the members of the library staff of the New York Academy of Medicine for their never-failing help and interest.

The following illustrations are reprinted with the kind permission of the publishers and copyright owners:

Joseph Lister at about age 40, from a photograph by Moffat of Edinburgh reproduced in the collected PAPERS OF JOSEPH, BARON LISTER, Vol. I, The Clarendon Press, Oxford, 1909.

Upton House, Lister's birthplace, from a photograph in JOSEPH LISTER, THE FRIEND TO MAN, by Hector Charles Cameron, William Heinemann Medical Books, Ltd., London, 1949, and in lord lister, 3rd ed., by Sir Rickman Godlee, The Clarendon Press, Oxford, 1924.

Joseph Lister at about age 28, from a photograph by Emery Walker reproduced in lord lister, 3rd ed., by Sir Rickman Godlee, The Clarendon Press, Oxford, 1924.

The Old Surgical Hospital (Royal Infirmary), Edinburgh, copyright by Francis C. Inglis & Son, Photographers, Edinburgh.

Agnes Syme Lister, from a photograph by Emery Walker reproduced in lord lister, 3rd ed., by Sir Rickman Godlee, The Clarendon Press, Oxford, 1924.

Bust of Joseph Lister, by permission of the Royal College of Surgeons of England.

ILLUSTRATIONS

JOSEPH LISTER AT ABOUT AGE 40

UPTON HOUSE, LISTER’S BIRTHPLACE

JOSEPH LISTER AT ABOUT AGE 28

THE OLD SURGICAL HOSPITAL (ROYAL INFIRMARY), EDINBURGH

AGNES SYME LISTER

BUST OF JOSEPH LISTER

1

“TENDERLY BELOVED SON"

On April 5, 1827, Isabella Lister gave birth to her fourth child and second son in the village of Upton, near London. The boy was given the name of Joseph, in memory of his great-grandfather, who, as a young lad, had set out in the early 1700’s from his native Yorkshire village to seek his fortune in London.

For centuries the Listers had been countryfolk, small farmers and tradesmen. Now, for the first time, one of the clan became a city dweller. The step was well taken. Great-grandfather Lister and his descendants—sober, hard-working people—prospered. Like so many Quakers, they became successful businessmen. On coming to London, the elder Joseph established himself as a small tobacconist. He had a number of children, the youngest of whom, John, rose to be a wealthy wine merchant and a respected member of the London Quaker community. John had two daughters and an only son. This son, Joseph Jackson Lister, was a man of many attainments and wide interests. He was a successful businessman and a self-educated scientist who, in his leisure hours, made contributions to the perfection of achromatic lenses that became the basis of the modern microscope. He was widely read and had a sound knowledge of literature, art, and natural history. He studied mathematics and optics without outside help while working for his father, a dour disciplinarian not given to pampering him.

While he was still at school (he was ten years old at the time), his father had once written to him saying that he had heard from his teacher that it often took him two and a half hours “in writing about io lines in a Copy, and learning a little spelling.” One hour, his father was “satisfied,” should be enough to “easily” accomplish this, and he was so annoyed with the boy for “wasting” an hour and a half that he did not send him a plum cake, as he had originally intended.

When, at the age of fourteen, Joseph Jackson left school to become an apprentice in his father’s business, his formal education came to an end. His schooling had been good, but elementary; he was determined not to stop there. The working hours of an apprentice were long and afforded little time for study. Joseph Jackson nevertheless managed, by iron self-discipline, to acquire more than average knowledge in many fields. His scientific work earned him the coveted Fellowship in the Royal Society of London.

Joseph Jackson’s situation was not unusual among Quakers of the time, for though Quakerism did not necessarily make its followers particularly suited for commerce, there were not many other occupations open to them. Because their religious faith forbade them to take a civil oath, they could not become lawyers, judges, or civil servants; because it forbade them to bear arms, they could not enter the Army or Navy; because it had no ordained clergy, they could not become ministers; because English universities admitted only Anglicans, they were excluded from most learned professions. Commerce and trade became, of necessity, the fields to which most Quakers turned and in which many of them excelled because of their earnestness of purpose.

Quakerism was not only a religion, it was a way of life. It forbade as useless pastimes the reading of novels, dancing, listening to music, or performing on musical instruments. It banned games of chance, horse racing, hunting, and going to the theatre as immoral diversions. It demanded humility and pride and resoluteness of character and a life lived according to the letter and the spirit of the Gospel. It was an attempt at practical Christianity. This was, indeed, a lofty ideal, and not easy to live up to.

In striving to follow the precepts of the Scriptures, the “Friends” (the name they had chosen for themselves, as “Quaker” was in the early days a name of derision) had adopted customs that were often resented and ridiculed. In an age of elaborate dress they wore simple, drab, old-fashioned clothes. In a period of deference they refused to bow or bend their knees or uncover their heads as a sign of homage except before God. In their speech they used the singular pronoun “thou” instead of the customary plural “you,” which they considered a form of flattery. This form of address infuriated “the rich and mighty,” who regarded it as disrespectful. “Why, you ill-bred clown,” they often bellowed at a Quaker, “do you Thou me?”

Their behavior and the rigidity with which they adhered to their religious beliefs, especially their refusal to take an oath, long made the Quakers objects of ostracism and persecution. Gradually, people recognized that they were sincere men and women of integrity and high moral standards who deserved, and eventually won, the respect of their fellowmen. But still they lived lives very much apart from their neighbors, seeking the company of their co-religionists rather than that of non-Quakers.

The education of their children was a matter of great concern to the Friends. There were many private schools for Quaker children whose parents could afford to pay their tuition, and there were also schools for needy children that were supported by the Society. The latter institutions were supervised and annually inspected by prominent members of the Society. On his first visit of inspection to Ackworth School, in Yorkshire, Joseph Jackson Lister met and fell in love with Isabella Harris, a twenty-two-year-old teacher at the school. Four years later, in 1818, the two were married.

The first years of their marriage were spent in London, where their three older children were born. Later Joseph Jackson acquired, at Upton, a village in Essex, a fine old Queen Anne mansion, surrounded by gardens and fields. It was here, at Upton House, that the younger Joseph and three other children were born.

Isabella and Joseph Jackson were devoted parents. The close ties that were formed between them and their children and among the children themselves remained firm bonds all their lives.

Life at Upton House was, despite its many restrictions, far from dreary. True, discipline was in many respects strict. Religious services—“meetings” the Friends called them—were attended with great regularity—twice on Sundays, once on Thursdays. Many of the amusements indulged in by non-Quakers were forbidden, but they were replaced by others: there were long walks in the country on which Joseph and his brothers and sisters were initiated by their father into the art of bird-watching and the science of botany. There were rides and outdoor games in summer, skating and parties in winter. Most important of all, there reigned at Upton House a spirit of affection and understanding.

We know little about Joseph’s early life. Godlee tells us that he was advanced for his age and that he was a high-spirited, normal boy. He was very much interested in natural history and fond of dissecting fishes and small animals. He also enjoyed taking their bones apart, freeing them of the surrounding tissues and then reassembling their skeletons. When Joseph was fourteen, he described, in a letter to his father, how he had set up the skeleton of a frog and pinned it on a small wooden board that belonged to one of his sisters. Not having asked his sister for permission to take the board, he wrote: “Do not tell Mary about the piece of wood.”

He was sent to two different Quaker boarding schools, both near London, where he was given a rounded education with special emphasis on the classics and English grammar and composition. He also studied modern languages, mathematics, and science. A good student, he was among the top boys of his class. His exuberance, or at least what his teachers regarded as exuberance, occasionally got him into trouble. “He is full of spirits,” one of the teachers reported to Joseph’s father, “which sometimes cause him to overstep the rules of order and bring him into a little disgrace.”

Since early childhood Joseph had said that he wanted to be a surgeon. As he grew older, the dream of a child developed into a more concrete desire. By the time he was fifteen, it had ripened into a firm resolve. His father did not encourage him in this decision. Joseph Jackson believed that one should “let nature do her own work,” rather than interfere. But he did not oppose his son’s wish. He did, however, insist that Joseph complete his formal education before entering upon the study of medicine.

Medicine had long been, and still was, regarded more as a craft than as a learned profession. There were many ways of becoming a doctor in those days. There were no hard and fast rules and regulations a man had to follow if he wanted to treat sick people. Many simply served an apprenticeship under a medical practitioner (who himself probably had had poor training) and then “walked the hospitals”—that is, went on hospital rounds as observers, here and there picking up medical knowledge as best they could. Others attended a medical school immediately after leaving preparatory school, without taking any further academic studies. Thomas Huxley, the famous biologist (Aldous Huxley’s grandfather), had no academic background. He never attended a university. Although many physicians were well-educated men who had had academic training and had also gone through medical school, the majority were not.

The choice of a university was not difficult for Joseph. As a Quaker, a religious “Dissenter,” he was barred from entering Oxford and was not very welcome at Cambridge. Oxford at that time admitted no Dissenters. Cambridge occasionally allowed them to matriculate, but refused them the right to take an examination or to acquire a degree. Until 1871, these universities did not open their doors to students who were not members of the Church of England and who did not officially subscribe to its thirty-nine articles of faith.

Since these were the only universities in England, members of other denominations—Protestants, Catholics, and Jews—founded, in 1826, a university in London, open to students of all faiths. Because of its secular character and its location in Gower Street, the new institution, University College, soon became known to London wits as the “Godless College in Gower Street.” It was nonresidential and all-male (no university admitted women in those days). It was a place for hard work. Men who went to University College went there to get an education, not to have a good time.

At the end of March, 1844, shortly before his seventeenth birthday, Joseph entered University College. It was an unattractive, dreary place, and Joseph’s early years there were not happy ones. Upton was too far away for him to live at home. He therefore lodged in town, together with three or four other students, under the guardianship of an older student of austere Quaker observance. Most of his time was spent attending classes or studying. There was little opportunity for outside activities or for making friendships. The cheerful boy, who had always enjoyed the company of others, soon became introverted and serious beyond his years. Recalling these years in later life, one of his fellow lodgers, his cousin Thomas Hodgkins, spoke of Joseph’s kindness and consideration, characteristics that were to be pronounced all of his life; yet he also spoke of Joseph as “rather dwelling apart.”

At the wish of his father, he worked toward his B.A., taking Latin, Greek, mathematics, natural philosophy (physics), astronomy, and, in preparation for his medical studies, botany, chemistry, and anatomy. It was a heavy schedule.

Joseph took his B.A., with honors, at the end of 1847, and had just begun his medical studies when, after an attack of smallpox early in 1848, he had a nervous breakdown. The austere life of the past few years, his probably too heavy schedule, followed by his serious illness—all combined to unsettle him mentally. He was thrown into a severe depression in which he felt himself responsible for all the evils and misfortunes of mankind. He had to interrupt his studies and take an extended leave of absence to regain his health. A long vacation in Ireland, the resilience of youth, and the loving understanding of his parents (in a charming letter his father addressed him as his “tenderly beloved son”)—all contributed to his recovery. At the beginning of the winter session of 1848-1849, he was back at work.

Joseph’s schedule at medical school was not lighter than it had been in the arts faculty. There were classes in anatomy, physiology, botany, chemistry, and physics; there were anatomical dissections to perform; there were lectures in medicine and surgery; there were visits to the hospital wards. In planning the students’ program, the medical school authorities did not show undue concern for providing much free time.

At Charing Cross Hospital Medical School, for instance, the students had lectures from nine to eleven; eleven to three was spent at the Infirmary or in the dissecting room; from three to five there were more lectures; five to seven was reserved for “Dinner and Relaxation,” after which the students again attended lectures until nine o’clock. On Saturdays they were free after five o’clock! This year-round program, with its “due allowance of time for mental relaxation and occasional recreation” (there were three recesses of about two weeks each), would, the school authorities felt, “effectually guard against the probability of the mind being too much fatigued, or the health injured by exertion or application too rigid and intense.”

Of the many outstanding teachers at the medical school, Dr. William Sharpey, the Professor of Physiology, probably had the greatest influence upon Joseph. Sharpey was one of a group of eminent scientists who had joined newly founded University College. He was an inspiring lecturer whom the students admired and revered. Joseph, too, fell under his spell. Even as an old man, he spoke of Sharpey as his “great master,” who had awakened in him his lifelong love of physiology and his perennial interest in microscopic work.

Joseph was also getting his first taste of surgery, and he found it to be very different from what he had expected. Operations were no longer as harrowing as they had been before the introduction of anesthesia, when strong attendants had to hold the more or less fully conscious patient down on the operating table while the surgeon wielded his knife and saw with the utmost rapidity. It had been a dreadful ordeal for everyone: for the patient, the surgeon, the spectators. For some it had been insupportable. Charles Darwin gave up the study of medicine after witnessing an operation performed on a small child, before the introduction of anesthesia.

Joseph had been present when anesthesia was used for the first time at University College. He was still in his liberal arts course, but occasionally attended lectures and operations at the hospital, as was customary for pre-medical students. On the morning of December 21, 1846, word had spread among the students that Dr. Robert Liston, the Professor of Surgery, was going to demonstrate something spectacular at two o’clock that afternoon. Letters, it was said, had been sent to important people in town, inviting them to be present.

The operating theatre was crowded when Liston entered at the appointed time. He addressed the audience briefly, saying that two days before he had received exciting news from America. A Boston physician, Dr. John Collins Warren, he had learned, was performing operations on patients who had been made insensible to pain by inhaling the vapor of ether. The innovation, if found to be effective, would be, he said, of the utmost importance. He had, therefore, immediately decided to put it to the test. In his obvious excitement, Liston almost stammered.

The patient, who was to have an amputation of the leg, was then brought in. An assistant applied the ether, two burly attendants held him down on the operating table, and Liston, who was not going to take any chances, prepared to operate with his usual rapidity. He grasped the patient’s leg with his left hand, there was a flash of the knife, the sound of sawing, and in twenty-six seconds the amputation was completed. There had been not a cry nor a groan from the patient. The “Yankee dodge,” as Liston smilingly called it, had been a complete success.

Anesthesia took much of the acute torture out of surgery. It did not lessen the dreaded occurrence of postoperative wound infection. On the surgical wards Joseph saw flushed and anguished faces, he heard groans and cries, he smelled the fetid odor of festering wounds, and he saw one out of every three patients upon whom an amputation of an arm or leg had been performed die of wound infection. He was experiencing the seamy side of surgery, and he was beginning to doubt whether he really wanted to be a surgeon.

Despite these doubts, Joseph’s outlook on life was happier than it had been for years. He had been appointed to the resident staff of University College Hospital, first as a house physician, then as a house surgeon. In the relaxed atmosphere of the residents’ quarters he regained some of his old cheerfulness and buoyancy. But still he was a very serious young man.

After four years at medical school, in 1852, Joseph took his M.B. (Bachelor of Medicine), and he passed the examinations for admission to the Royal College of Surgeons of England. During these busy years he had also found time for laboratory work, and he now had the thrilling experience of seeing his first paper in print. It was on a microscopic examination of the muscular tissue of the iris, the colored membrane of the eye, in which Joseph showed that the iris contained two separate muscles, one for contracting, the other for dilating the pupil. The one made the pupil smaller, the other made it larger. This was a very important observation, and the paper attracted a great deal of attention. This publication was soon followed by another, which was also very well received. Joseph was beginning to make a name for himself.

2

“A GLORIOUS OCCUPATION”

It was now time for Joseph to think of going into private practice—naturally in London. His family connections, his friends and colleagues, his roots—all were there. The opportunities for building up a successful practice were good.

He had had excellent training and considerable hospital experience as a house surgeon in medicine and in surgery at University College Hospital. Still, he felt the need for more surgical training. It was one thing to work in a hospital where one could always get advice from an older man; it was quite another to be on one’s own.

Professor Sharpey, with whom he discussed these problems, agreed. He advised Joseph to go to Edinburgh for a month or so, and then for a longer time to the Continent. He would thus become acquainted with the work of surgeons outside of London. Under this plan, Joseph should be back and at work in London in six or seven months. He was not to return, except as an occasional visitor, for almost a quarter of a century.

In September, 1853, Joseph went to Edinburgh with a letter of introduction to Sharpey’s lifelong friend, Dr. James Syme, the Professor of Clinical Surgery at the University of Edinburgh. Syme, who was apparently immediately attracted to the serious young man, received Joseph warmly. He not only gave him the permission to work on his wards at the Royal Infirmary, he allowed him to assist at his private operations.

James Syme was a colorful, fiery Scot with no special liking for London doctors. He had been appointed Professor of Surgery at University College in 1848, but he had soon left this post after violent quarrels with his colleagues. He had returned to his native Edinburgh to resume his work at the Royal Infirmary. Now fifty-four years old, he was regarded by many as the most prominent British surgeon. His reputation as a teacher of surgery was equally great.

Joseph was no less attracted to Syme than Syme to him. He was fascinated by Syme’s lectures and he found him a superb surgeon. To work under such a man should be, he felt, of immense value. Before the four weeks of his stay in Edinburgh were up, he asked for permission to remain for the winter. He had given up the idea of going to the Continent—at least for the present.

To Joseph’s delight, Syme soon afterward offered him an appointment as supernumerary house surgeon, a position that gave him the opportunity for much surgical work. It was a happy time for Joseph. He became more and more convinced that surgery—“this bloody and butcherly department of the healing art,” as he had called it in a letter to his father—was the right field for him. He sometimes questioned whether it was possible for such a “delightful pursuit” to continue.

During the winter of 1854 there occurred a chance event that was to change the whole course of Joseph’s life. Syme’s regular house surgeon had to leave unexpectedly, and Joseph stepped into the vacancy. The appointment was to be for one year. It was a position that Joseph could readily have regarded as beneath his dignity to accept. He had been a house surgeon in medicine and in surgery at University College Hospital; he had done important work in research; he was a Fellow of the Royal College of Surgeons of England. Besides, house surgeoncies were usually held by men much younger than himself, and also much less experienced. That he accepted Syme’s offer shows his total lack of false pride.

It was a decision Joseph never regretted. Syme, fully aware of the situation, treated him more as a junior colleague than as a house officer. He gave him considerable authority and freedom of action. Joseph, in turn, looked up to Syme with admiration and devotion. An attachment was being formed between the two men that was to last for the rest of their lives.

Again fate played its inscrutable role. Joseph’s house surgeoncy was to last until February, 1855. At its termination he would, in all probability, return to London. He had already been away much longer than originally contemplated. It was time for him to get settled at home.

Some three to four months before he was to relinquish his post, news of the tragic death, in the Crimea, of Dr. Richard Mackenzie reached Edinburgh. In the spring of 1854, Mackenzie, an Assistant Surgeon on the staff of the Infirmary and a lecturer at the University, had volunteered for medical service with the English forces at the outbreak of hostilities between the Russians and the allied English and French. The young surgeon had hoped to return home by November. In October he had died of cholera.

Mackenzie had been a promising, well-liked physician, with every prospect of a brilliant career. In fact, many believed that he would one day succeed Syme as Professor of Clinical Surgery. A cruel fate had put an end to all this.

On learning of Mackenzie’s death, Joseph’s friends urged him to apply for the assistant surgeoncy. They could think of no more worthy successor. Joseph was anxious to follow their advice, but it was a hard decision to make. It would mean that he would not return to London, and he knew that this would be a great disappointment to his father.

For four months Joseph could not bring himself to tell his parents about his plans. All through the winter he avoided mentioning them in his letters. But when Syme, who at first did not approve of his intention to forsake London, finally agreed to support his candidacy, Joseph wrote his father a long letter explaining that he was convinced he should not let “this unrivaled opportunity of advancing in [his] profession” go by.

True, he wrote, it would depend entirely on himself (under the blessing, if he might humbly say so, of God) whether he succeeded or not. But he was encouraged to hope, though he could not expect to be a Liston or Syme, that he would get on. “Certain it is I love surgery more and more and this is one great point; and I believe my judgment is pretty sound, which is another most important point. Also I trust I am honest and a lover of truth, which is perhaps as important as anything.” And with characteristic modesty, he added: “As to brilliant talent I know I do not possess it; but I must try to make up as far as I can by perseverance.”

And so Joseph declared himself a candidate for the assistant surgeoncy. He was to wait some time before a decision upon his application was reached.

The preceding fall, he had been appointed “extramural lecturer” at the Medical School, a much sought-after position that afforded ambitious young men the opportunity of lecturing to the students before attaining professorial rank. Extramural lectures, as the name implies, were given outside the University in rooms rented for the purpose by the lecturer and at his own expense. Appropriate premises were scarce and hard to get. Joseph was fortunate in obtaining the room previously used by Mackenzie.

In planning for his course, which was to begin early in November, 1855, Joseph decided to discuss, among other topics, inflammation, a phenomenon much feared and often encountered by the surgeon. Although it was so common in surgical practice, it was a little-understood, controversial subject over which surgeons were at loggerheads.

The most recent contribution to the problem had been made by one of Joseph’s former teachers at University College, Professor Wharton Jones. Professor Jones was an eminent scientist for whom Joseph had great respect. His paper on inflammation had been very well received; it had, in fact, received a prize, but Joseph disagreed with its conclusions. He believed that Jones had chosen a wrong experimental approach and had therefore arrived at a wrong answer. By using strong chemical irritants from the beginning to induce inflammation, Jones had, in his opinion, masked its early stages, stages essential for the understanding of the whole process. He should have started with a mild stimulant.

It all seemed so simple to Joseph. All that he would need to prove his point was time—time to carry out the necessary experiments. And that was what he did not have. In six weeks he was to give his opening lecture, and he was far from being prepared. The thought of not being ready on time almost gave him nightmares.

He was in a dreadful dilemma. He could not conceive of going into his course poorly prepared nor could he bear the thought of postponing the experiments. His scientific inquisitiveness triumphed, and throwing aside his caution, he embarked one evening on his investigations.

He had procured a large frog from a nearby lake, and with an assistant he observed under the microscope the effect of first tepid and finally scalding water on the arteries in the web of the frog’s foot. Glued to the microscope, the two young men worked late into the night—“a most glorious night” Joseph later called it—tracing the process of inflammation step by step, “in a more satisfactory way than it had ever been traced before.” So thrilled was Joseph that, as he wrote to his father, he repeatedly burst into “involuntary exclamations of delight.”

The experiments were continued during the following weeks. They not only contributed to a better understanding of inflammation, they “exploded completely the false theories of two or three authorities,” as Joseph proudly commented.

On the fateful day of his introductory lecture, November 7, 1855, some fifty students (a number he was not soon to have again) attended and applauded enthusiastically. But the next day, and for a long time thereafter, few returned. Extramural lectures were optional!

Although Joseph’s early lectures attracted few students, those who came were very much impressed. They sensed that the lecturer was an unusual person, a man with original ideas. They generally regarded him as a “great thinker,” and they treated him accordingly. Their regular attendance at a course for which they received few credits was a real mark of their esteem.

To accomplish all he had undertaken to do, Joseph had imposed upon himself a very rigid routine. He went to bed at ten and got up at 5:30. He breakfasted on coffee, which he prepared while dressing, and a “bit of bread.” He then worked on his lecture for three or four hours and delivered it at ten, when his mind was “brim full of it.” The afternoon was spent at the hospital; the evening was his own, for reading or for dining out—very often at Millbank.

At Millbank House, Syme’s lovely home on the outskirts of Edinburgh, he was a welcome guest—probably even more welcome to Agnes, Syme’s eldest daughter, than to the professor himself. Like her father, Agnes had at once formed a strong attachment to the attractive young Englishman with the grave manner and the sober black garb of the Quaker. It soon became evident that Joseph, too, had fallen in love. In July of 1855, Agnes and he had become engaged.

Joseph could not have made a better choice. According to Victorian standards, Agnes was not especially accomplished: she did not perform on the piano, she did not dabble in painting, nor was she addicted to reciting poetry. But she was gay and high-spirited, and she had inherited her father’s strong intellect. On the evidence of her photographs, she does not seem to have been very pretty. Her straight hair, parted in the middle of her head, partly covered a clear forehead; her nose appears to have been too large, but the thoughtful eyes are those of a highly sensitive and introspective individual. A friend of her father’s, the physician and writer Dr. John Brown, who had treated her for a serious childhood illness during which she had been completely unconscious for several days, said of her: “Agnes was once in Heaven for three or four days when she was a very little child, and she has borne the mark of it ever since.”

Since Agnes was not a member of the Society of Friends, Joseph was, in Quaker terminology, “marrying out.” It was a step not to be taken lightly, for it meant forfeiting membership in the Society. Joseph could choose between being expelled (“disowned” was the word used by the Friends) or having to resign. He chose resignation.

In severing his ties with the Society of Friends, Joseph gave up the outward characteristics of Quakerism—its somber dress, its austere, restricted way of life. To its moral and ethical principles he remained true. The close relationship between Joseph and his father, who was saddened by his beloved son’s departure from the Society, suffered no break.

Joseph and Agnes’s marriage took place in April, 1856, in the drawing room of Millbank House. The young couple then spent some time in the beautiful Lake District of Northwest England and at Upton House with Joseph’s family. From there they went to the Continent.

Joseph Lister at about age 28

It was a glorious trip that combined sightseeing and study. After crossing the Channel, they visited Brussels and then took a boat trip up the Rhine to Switzerland. From there they went to Italy and then by “diligence” (stagecoach) to Vienna.

Italy, “that lovely but melancholy land,” as Joseph called it, “with its teeming records of former greatness in science and art,” made a deep impression upon him. He found the people kind and graceful, but “sleeping in the paralyzing chains of political and spiritual tyranny.” For centuries the heavy hand of Italian and foreign despots had lain on the unfortunate country, putting an end to the magnificent cultural achievements of the Italian people. It was indeed a period of great oppression, which the young Englishman viewed with distaste.

In Italy Joseph visited several medical schools and some well-known surgeons. In Vienna he was the guest of Professor Rokitanski, the most famous pathologist of the day. Then, after visiting hospitals in Germany and spending a few days in Paris and at Upton House, the Listers returned to Edinburgh at the beginning of October, 1856. They were greeted by the welcome news that Joseph had been unanimously elected to Mackenzie’s former post of Assistant Surgeon to the Royal Infirmary.

After his prolonged absence, Joseph went back to work with increased intensity. In the middle of November he started his second course of lectures. Soon afterward he presented two scientific papers in which he reported on some of his laboratory research. One paper was read before the Royal Society of Edinburgh, the other before the Edinburgh College of Surgeons. At twenty-nine, Joseph was rapidly gaining recognition as a rising young doctor.

At the end of the winter, Professor Syme had to be out of Edinburgh for a short time. During his absence, Joseph took his place in operating before the students, an assignment faced by the young surgeon with considerable apprehension. His “debut,” as he called it, was very successful. Shortly thereafter he wrote the following letter to his sister Jane. There could be no better indication of the kind of man he was.

One hasty line to tell thee how the second set of operations went off. I performed two more on the 7th day before the students: one of them an exceedingly interesting case, and also requiring a very ticklish operation, [namely] the removal of a rather large tumor from the armpit, from among large and important blood-vessels and nerves. I felt this would be a fair trial of my self-command; for the business was very much more trying than the amputation of a thigh or any other ordinary operation. The theatre was again well filled, and though I again felt a good deal before the operation, yet I lost all consciousness of the presence of the spectators during its performance, and did it exactly as if no one had been looking on. I feel, I may say, truly thankful I was able to go through it as I did. Just before the operation began, I recollected that there was only one Spectator whom it was important to consider, One present alike in the operating theatre and in the private room; and this consideration gave me increased firmness.

... I trust I may be enabled in the treatment of patients always to act with a single eye to their good, and therefore to the glory of our Heavenly Father. If a man is able to act in this spirit, and is favored to feel something of the sustaining love of God in his work, truly the practice of surgery is a glorious occupation. I may say I never felt better pleased with my profession than now.

Besides his hospital work, which was occupying more and more of his time (Professor Syme was giving him increasingly large responsibilities), and his lectures, Joseph continued his laboratory research. He was now working on the clotting (coagulation) of the blood. It was a subject of great practical importance, especially for the surgeon. Without clotting, bleeding from severed blood vessels would go on indefinitely. What caused clotting was not clear. Numerous explanations had been advanced, none of which satisfied Joseph. Only recently a prominent physician had propounded yet another new theory. In Joseph’s opinion it, too, was invalid.

During his investigations on inflammation, Joseph had observed that in normal, healthy blood vessels clotting never occurred. On the other hand, if the vessels became inflamed, the blood stagnated and changed its appearance. The condition of the blood vessels, Joseph decided, obviously had something to do with coagulation. Starting from here, Joseph became engaged in extensive, time-consuming research. Often until late into the night he sat in his laboratory, pondering and experimenting, with Agnes at his side, filling page after page with his dictation.

In the summer of 1859, the Professorship of Surgery at the University of Glasgow became vacant through the death of its incumbent, Dr. James Lawrie. Many of the Glasgow professors, at their head Joseph’s old friend Dr. Allen Thomson, believed Joseph to be the best man for the job. Of the seven candidates for the post, he was unquestionably the most outstanding.

The Glasgow professorship was one to which the holder was appointed by the Crown, at the recommendation of the Home Secretary. In view of Thomson’s good relations with the government in London and his own qualifications, Joseph’s appointment appeared certain.

Jockeying and pulling of strings behind the scenes during the following months made the outcome of the contest less sure. In December, Joseph heard, unofficially, that he had been appointed. The information turned out to be incorrect. When at last, at the end of January, an official letter arrived, “signifying that Her Majesty had approved of [his] appointment,” Agnes and he were “almost intoxicated with gladness.”

At a testimonial dinner in his honor, Joseph spoke of his great debt to Edinburgh, where, as a stranger, he had been so cordially received and given so many opportunities for advancement. He spoke of “the illustrious Professor of Clinical Surgery” (Syme) as the master under whom he had served an apprenticeship from which it was his own fault if he had not benefited. He believed he had humbly endeavored “to act in the spirit expressed by the Roman moralist [Horace] who said: 'Quid verum atque decens euro etrogo. . .    ” (“I strive and earnestly seek for what is true and decent. . . .”) For the physician, the “verum” would always be the “decens”; scientific truth, since it bore directly upon the well-being of his fellow creatures, would always be a proper object of the physician’s pursuit. And while there was probably no calling in which there was a greater opportunity for deception than in medicine, there was also —since the public placed itself so trustingly in the physician’s hands—no calling in which falsehood was more unbecoming or more despicable.

The Listers stayed in Edinburgh until the spring of 1860. Before they moved to Glasgow, Joseph’s induction as a professor took place. On the morning of March 8th, he received a letter from Professor Thomson, informing him that the ceremony would be held the next day, at three o’clock in the afternoon. This was short notice. Naturally Joseph had worked on the address he was to deliver—in Latin—before the Academic Senate. But he was far from ready. It was an embarrassing situation. After laboring almost all through the night, he finally completed the speech on the train to Glasgow.

To his disappointment, he did not even have the opportunity to deliver all of it. After speaking for a short while, he was interrupted by the Principal and asked to leave the room for a few minutes. He was told upon returning that the Senate had heard his dissertation “with great satisfaction.” Joseph suspected that no one in his audience, except perhaps the Professor of Humanity, had understood a word of what he had said.

Soon after Joseph’s induction, the Listers moved to Glasgow. His professional position was now very different from what it had been in the past. In Edinburgh he had been a promising young surgical assistant. In Glasgow he was the duly installed Professor of Surgery, with all the honors and duties that went with the position. Oddly enough, no hospital appointment was attached to the academic post. For more than a year, until his appointment to a surgeoncy at the Royal Infirmary, Lister’s active surgical work was limited to his private practice, which was beginning to develop rapidly. (In Edinburgh he had had so little private work that Agnes, in a letter, once jokingly alluded to “Poor Joseph, and his one patient.”)

During his first Glasgow summer, Lister gave a course of lectures as a kind of warming up for his coming regular winter course. He wanted to get used to speaking in a large auditorium before a large audience. Until now, he had lectured to only a handful of students in a small room. His official Introductory Lecture would be on a different scale. He looked toward it with some apprehension.

An opening lecture, especially in the case of a new professor, was always an event of special importance. It was usually faced with some nervousness by the lecturer and awaited with considerable curiosity by the students, who wanted to see what the new man was like.

On the day of Lister’s Introductory Lecture, the auditorium was packed. The students, who were on their best behavior, not only took off their hats—an unusual sign of respect—they sat through the lecture in exemplary silence, captivated by the eloquence of the young professor. When he concluded by impressing upon them that the two great requirements for the physician were “a warm, loving heart and truth in an earnest spirit,” they cheered him loudly.

Joseph’s popularity grew as the course progressed. In response to Professor Syme, who, in a postscript to a congratulatory letter, had written, “Let me hear your numbers,” he proudly wrote that he had 180 students! It was an attentive, orderly crowd that did not even scratch the new desks, one of the embellishments of the auditorium provided by Joseph at his own expense.

At the end of the course the students sent him a testimonial, written on parchment, telling him that they could not let this first session of his professorship close without formally expressing their high opinion of his lectures, and recording their testimony to his “eminent ability as a teacher of Surgery.” They also elected him Honorary President of the Students’ Medical Society.

One of Lister’s new duties was to examine the students for their medical degrees. It was an assignment not taken lightly by a man of his disposition. He approached it with a feeling of great responsibility. For the written examination he devised a set of questions and an intricate method for evaluating and grading the students’ answers. He spent hours on end, “with scarce a moment’s respite from close attention,” in giving the orals. He tried to the best of his ability to form an opinion of what he called the students’ “merits or demerits.”

In addition to lecturing and conducting examinations, Lister spent much time writing. A London physician, Dr. Timothy Holmes, had had the idea of assembling in a standard work the current methods of surgery. The individual chapters of the book were to be written by a group of London physicians, and Dr. Holmes asked Lister, the only non-Londoner, to contribute articles on amputation and anesthesia. It was a singular expression of the esteem in which the young Glasgow professor was held.

With his appointment, in the summer of 1861, as Surgeon to the Royal Infirmary (three other physicians held the same rank), Lister entered upon a new and important phase of his career. He now headed a department of his own with all the responsibilities and advantages of such a position. Now, as never before, he had the opportunity of showing his mettle.

And again there was the burdensome task of performing a first public operation. Again he faced the occasion with anxiety. As in the past, once he had started operating he was perfectly at ease. The next day, Agnes wrote Joseph’s mother that it had been “a triumphant success.”

That his heavy teaching and hospital schedule gave him so little time for research weighed heavily upon Lister. His studies on inflammation and on the coagulation of the blood had thrown much light on these poorly understood phenomena. But there was still so much to do. It was not in Lister’s nature to be satisfied with partial answers. He had to get to the bottom of things, clarify a problem as far as possible. He simply had to find time to pursue his studies. He did.

In June of 1863 he was to present his findings on coagulation before the Royal Society of London. At the end of March he wrote his father that pressure of work had kept him from making the necessary preparations for the lecture. “Thee can understand how desirous I must be to make what preparation I can for the . . . lecture, and yet often from week’s beginning to week’s end I have been unable to give even a thought to it, except regret that I cannot think of it.”

Before he could even “think of beginning to prepare” the paper, he would have to carry out further experiments and also revise Agnes’s notes. The difficulties seemed insurmountable. Yet he could not go ahead while he felt that he could contribute so much to the further clarification of the problem (coagulation of the blood) if only he found the time for more experimentation.

Lister was a man with an iron will. Since he could not conceive of giving his scheduled lecture without carrying out the necessary experiments, he carried them out, despite all obstacles. On June 11th, the paper was duly delivered.

As time went on, Lister found it increasingly difficult to engage in laboratory research. He was very successful as a surgeon and teacher, but in his heart of hearts he wanted to be a researcher, for in research, he felt, lay his strength. The inability to follow this inclination was a source of real concern to him.

Under these circumstances, it is understandable that when the Edinburgh Professorship of Systematic Surgery, a post in which he could do more research, became vacant, Lister applied for the position. His friends, and he himself, felt certain that he would get the chair. His candidacy was unsuccessful.

Two years later he applied for a professorship at University College, London, his alma mater. Again another man was given the post. On receiving this news, his aged father, writing to his “own dear son,” told him that he could “hardly forbear” to express to him his condolence. “It must be very disappointing to thee as to all of us—but most of all to myself, who had fondly hoped for thee to be nearer to me during the short time that might remain to me in this changing world. . . Joseph’s disappointment was at first “extremely severe.”

Syme, whose memories of London were not pleasant, wrote that although London no doubt had its advantages, it was necessary to do “a great deal of dirty work” to maintain a good place there—something he was quite sure Joseph would decline to do.

It was Glasgow, therefore, which would be, in the coming years, the scene of Lister’s most important discovery—the discovery which was to provide the impetus for his life’s work.

3

“THE BEAUTIFUL RESEARCHES OF PASTEUR”

Since his earliest medical days, as a young house surgeon at University College Hospital, Lister had been deeply distressed by the prevalence of wound infection on surgical wards. The apparent impossibility of preventing this dread condition, with all its suffering and dangers, once almost made him give up the idea of becoming a surgeon.

On Syme’s wards, conditions had been somewhat better, but even there, under the best possible management, the occurrence of wound infection seemed inevitable. Why this should be was quite inexplicable.

Now, on his own wards, he was encountering wound infection with increased frequency. It had been long observed that wound infection was especially prevalent on wards in which the patients’ beds were very close to one another, and it was also becoming evident that a patient would almost always become infected if he were bedded next to another patient with an infected wound. Apparently something, some kind of poison, was being transmitted from one patient to another.

Personal cleanliness was not a conspicuous characteristic of the period. Bathing was infrequent, and the smallness of the wash basins makes a modern viewer shudder. In hospitals, surgeons and nurses went from one patient to another, dressing their wounds, without even first washing their hands. Operations were performed by the surgeon in his oldest, most blood-crusted frock coat. (The older and bloodier the coat, the more experienced, apparently, the operator must be.) Instruments undoubtedly were washed—after an operation. How little aware surgeons were of the repulsiveness of their appearance is well illustrated by a story told about Sir Astley Cooper. Called hurriedly one day from an operation to his patient, King George IV, Sir Astley appeared in blood-bespattered clothes. The king was taken aback. Sir Astley was astonished at his fussiness.

In an attempt to combat the spread of wound infection, Lister insisted upon scrupulous cleanliness on his wards. Large basins of water and huge stacks of towels were placed everywhere; doctors and nurses had to wash their hands carefully before and after dressing a patient’s wounds. There was a standing rule that all patients with suppurating wounds (those producing or discharging pus) were to have their dressings changed frequently.

To the managers of the Infirmary such procedures appeared unnecessarily extravagant; to many of Lister’s colleagues they were a source of amusement; to others, who had come to look upon wound infection as inevitable, they were regarded as an almost profane attempt to fight against the decrees of the Almighty. But the worst thing was that Lister’s attempts were really of little avail. Wound infection remained rampant.

Since the introduction of anesthesia, some fifteen years before, surgery had made considerable progress. In the past, surgeons had tried to perform operations with the greatest possible speed in order to shorten the patient’s fearful agony. The faster a man could operate, the greater was his reputation. Robert Liston, the great London surgeon who had been one of Lister’s teachers at University College, prided himself on being able to amputate a leg in thirty seconds or less.

Things now were different. With the patient quietly asleep and unconscious of what was going on around him, the surgeon could take his time. He was able to proceed step by step, tying off bleeding vessels in order to get a better view of the tissues he was about to sever, pushing aside other tissues without damaging them, conserving as much as possible of an arm or a leg or an organ.

New and better operations were being developed.

Surgical techniques were being perfected. Surgery was becoming an art. But it still remained a dreadful gamble. “The man laid on the operating-table in one of our surgical hospitals,” wrote the famous Edinburgh physician Sir James Simpson, “is exposed to more chances of death than was the English soldier on the field of Waterloo.” Although Sir James was given to expressing himself somewhat dramatically, this statement was, unfortunately, not too far from the truth, considering the fact that, on an average, one out of every three patients died following the amputation of a limb.

The great hazard was wound infection, all too often followed by blood poisoning and death. Even the most competent surgeons were constantly faced by this dreaded complication. They knew of no method to avoid it, nor did they understand why it occurred. Every operation came to be looked upon as a game of chance, played for the highest stakes. A well-known German doctor compared the surgeon who had completed an operation with the farmer who, having sown his field, awaited with resignation what the harvest might bring, fully conscious of his inability to influence the elements which might bring down upon him rain, hurricane, and hailstorm.

Wound infection and its complications—erysipelas (infection of the skin), gangrene, and blood poisoning—were rampant on surgical wards. Occasionally they were seen also in people operated upon outside a hospital, but they were so common in hospital practice that surgeons came to regard them as being related in some unknown manner to the hospitals themselves. They had something to do, it was argued, with what was termed the “fabric” of the hospital—so much so that they became known as “hospital diseases,” and their occurrence was spoken of as due to “hospitalism.”

Although a word had been found for this dreadful condition, its nature remained a deep mystery. To attribute it to something as intangible as a “general morbid condition” of the hospital or to its atmosphere was of no great help. To say that it was due to overcrowding of wounded persons came closer to reality. But however doctors tried to explain hospitalism, they could not prevent the occurrence of hospital diseases. Once they became established in a hospital, they were there to stay. No known hygienic measure could dislodge them. The hospital was doomed. Often there was nothing left but to abandon and sometimes even to demolish it.

That the older hospitals were contaminated was almost taken for granted. That the new ones should have the same fate was hard to face. After barely two years, the splendid new surgical building of the Glasgow Royal Infirmary had become so infection-stricken that Lister sometimes felt it a questionable privilege to be connected with the institution.

People dreaded having to go to a surgical hospital. To many it seemed like receiving a death sentence. For many it was. Whoever could afford it was operated upon at home or in the surgeon’s office. Only the poor and destitute submitted to being hospitalized. For them it was the only possible means of receiving medical care. “Through the wards of these hospitals,” wrote a prominent surgeon many years later, “there ever stalked the specter of Sepsis to the accompaniment of the beating of the wings of the Angel of Death.”

The outcome of even the most trivial operation was unpredictable. A strapping young farmer, whose bride thought his nose was too big, decided to have it operated upon. He paid with his life for his rashness. Three days after the operation he was dead, a victim of blood poisoning.

Such uncertainty and the inability of the surgeon to influence the outcome of an operation weighed heavily upon Lister. He was a skillful and painstaking surgeon. Still, despite all possible care, his patients were always threatened by wound infection, with its fearful suffering and dangers.

Recently he had perfected a brilliant operation for the treatment of tuberculosis of the wrist. The operation, which consisted of removing the eight small wrist bones, together with the ends of the radius and of the ulna (elbow bone), was complicated, difficult, and time-consuming. Lister himself called it a “troublesome performance,” but it saved the patient’s hand from amputation and restored its usefulness. Such objects were, in his words, “well worthy of any labor involved.” Indeed, he spared himself neither time nor effort, and still, out of fifteen patients upon whom he performed the operation, six developed gangrene and one blood poisoning. Little wonder that he regarded wound infection as “one of the greatest opprobia [disgraces] of modern surgery.” The longer he pondered the problem of wound infection, the more firmly did he become convinced that it was connected in some inexplicable way with the hospital air. Again and again he had noticed that patients who had been admitted to the hospital with a compound fracture almost invariably became the victims of wound infection. Patients with a simple fracture rarely did. This was hard to understand. A fracture apparently is a fracture. He tried in vain to explain why in the one instance there was wound infection, while in the other there was not. He could not find the answer. But he was deeply convinced that the difference in behavior between simple and compound fractures was at the bottom of the whole problem of wound infection. The man who could explain this difference and make a compound fracture behave like a simple one would become, he once told his class, one of the greatest benefactors of his age.

How do compound and simple fractures differ? In compound fractures, the skin is broken; in simple fractures, it remains intact. In the first case, the wound is exposed to the air; in the latter, it is not. Suddenly it dawned upon Lister that the crucial factor responsible for infection was exposure of the wound to the hospital air. Something in the hospital air caused putrefaction (rotting) of the wound, which was followed by suppuration (pussiness). What this something was, he could not say. Again he was at an impasse.

Then one day, while reading the publications of a young French chemist, “something like scales fell from his eyes,” in the words of the Bible, and the reason for the putrefaction of wounds suddenly became clear to him. In what he later called “the beautiful researches of Pasteur,” Lister had found the key to the mystery of wound infection.

In 1854, Dr. Louis Pasteur was appointed to the Professorship of Chemistry at the University of Lille. Thirty-two years old, he had already made a name for himself through his brilliant work on the optical activity of crystals, and he was regarded as one of the most prominent chemists in France. In his new post, he was to embark upon investigations that were, in time, to make him one of the greatest biologists of his day.

During the summer of 1856, a Monsieur Bigo, the owner of a local distillery for the manufacture of beet alcohol, approached him with a request for help and advice. Monsieur Bigo, like many of his colleagues, was encountering serious difficulties at his plant. Something had misfired during the fermentation of the beet juice. Large quantities of lactic acid were forming in the vats and were spoiling his alcohol. Monsieur Bigo had attempted, in vain, to correct the faulty fermentation. He was at his wits’ end. At the suggestion of his son, a student in Pasteur’s laboratory, the desperate distiller turned to the young professor.

Pasteur, always willing to help, put himself at Monsieur Bigo’s disposal. He spent much time at the distillery carefully observing the various operations: the pressing out of the beet roots, the addition of the brewer’s yeast to the beet juice, the course of the fermentation in the vats. He took samples of the beet juice during different stages of the fermentation process and examined them under his primitive microscope. After several weeks he was able to tell Monsieur Bigo that his difficulties were being caused by a second yeast that had invaded the vats and was fermenting the beet sugar to lactic acid. Above all, he was able to show how the undesirable lactic acid fermentation could be avoided.

We can be certain that Monsieur Bigo was delighted by the young chemist’s ingenuity. What he did not and could not realize was that he had witnessed the beginning of one of the most far-reaching scientific developments of the nineteenth century. Unwittingly, he had led Pasteur into research that laid the foundations of our knowledge of the microbe.

Now that he had solved Monsieur Bigo’s immediate problem, Pasteur turned to the problem of fermentation as such. Several kinds of fermentation were known. The fermentation of beet juice or grape juice, which led to the formation of alcohol (if everything went well), was called “alcoholic fermentation.” Sometimes things did not go according to program, as in Monsieur Bigo’s distillery, and there was a formation of lactic acid, spoken of as “lactic acid fermentation.” At times the fermentation of grape juice produced not only the desired alcoholic beverage (wine) but also vinegar, through a process called “acetic acid fermentation.” Then there was the souring of milk, a process due to the fermentation of milk sugar to lactic acid.

In painstaking studies, Pasteur found that the various types of fermentation were caused by a variety of living microorganisms (yeast and bacteria) and that in each instance the chemical process was due to a different microorganism. One was responsible for alcoholic fermentation, another for lactic acid formation, a third for the production of vinegar, and so on.

Supposedly closely related to fermentation was the decomposition of certain substances such as meat and eggs. This process, which was accompanied by the development of foul-smelling gases, was known as “putrefaction.” It had been attributed some twenty years earlier, by Dr. Schwann of Berlin, to germs contained in the air. Schwann’s ideas were not accepted by other scientists, who claimed that the oxygen of the air, rather than germs, was responsible for putrefaction. Pasteur, however, now showed that putrefaction, too, was caused by germs.

What was the origin of these minute but powerful “mysterious agents”? he now asked himself. Did they arise suddenly out of the void, without predecessors, or did they stem from parent cells that had inhabited the earth for eons before them? Unexpectedly, Pasteur had become involved in a controversy that had long exercised scientists, the question of whether life could originate anew from inanimate matter or whether all living things, even the smallest, apparently most insignificant creatures took their origin from others like themselves. He had come to the age-old question concerning “spontaneous generation.”

The adherents of spontaneous generation maintained that living things could arise anew if circumstances were favorable. One well-known seventeenth-century scientist went so far as to give a recipe for making mice, while others described ways of producing frogs out of the mud of marshes and eels from the water of rivers. The first decisive blow against the concept of spontaneous generation was delivered by the Florentine scientist Count Reti. In Reti’s day (the second half of the seventeenth century), it was generally believed that worms originated from the decay of dead bodies or from the filth of any kind of decaying matter. To prove the falseness of this view, Reti carried out many ingenious experiments. On the basis of these investigations, he concluded that the worms which were so often found in decaying meat had not arisen there anew (“spontaneously”), but had hatched out of the eggs deposited there by flies. To prove his point, Reti placed some meat in a large vase covered with a fine veil, which allowed air to enter. For further protection against flies, he placed the vase in a frame covered by a similar net. No worms were ever found in the meat, although many were seen crawling on the covering net.

Step by step the proponents of spontaneous generation were forced to restrict their claims to ever smaller organisms, until in Pasteur’s day they contended that only the smallest organisms—the microbes or germs—could arise spontaneously. They clung stubbornly to this view. They were routed by Pasteur. In ingenious experiments he showed conclusively that there was no such thing as spontaneous, new formation of living cells. All cells stemmed from parent cells. Where the first cell came from, nobody could tell. The answer to that question depended upon a man’s philosophical or religious beliefs.

After he had discovered that all fermentation and putrefaction were the work of living microorganisms, Pasteur showed that many of them existed floating in the air. In fact, he found the atmosphere of inhabited areas teeming with germs! If these germs got into an appropriate medium (in Pasteur s experiments a fermentable or putrescible liquid), they not only caused fermentation or putrefaction, they also multiplied. Their multiplication—that is, their growth—could be checked by heating the liquid to 6o° C., a process later known as “Pasteurization.” Bringing the liquid to a boil killed the germs outright. If, on the other hand, the germs (but not the air) were prevented from getting into a “sterile” liquid, the liquid remained unchanged—a clear proof that the germs, and not the oxygen of the air, were the cause of fermentation and putrefaction. The young French chemist had made a discovery of enormous significance to science and, ultimately, to all mankind.

4

“THE WONDERFUL VISION”

Eagerly, Lister read of Pasteur’s discoveries, fascinated by the brilliance of these beautifully planned and executed investigations. They not only made clear what it was that he had long held responsible for the putrefaction of wounds, they also held out the hope of conquering wound infection. Now that he knew against whom to direct his attack, he no longer had to fight in the dark. If Pasteur’s germs could be prevented from getting into an open wound or be destroyed after they had invaded it, these scourges would be a thing of the past. He dedicated the rest of his long life to this lofty aim. Little did he realize how thorny the path would be.

In his investigations, Pasteur had killed germs through heat. In surgery such a method would obviously not do. Here something else would have to be used—possibly a chemical. In his search for a suitable substance, Lister recalled being “much struck” by a report on the remarkable effect of carbolic acid upon the sewage of Carlisle, a town in southern Scotland. In those days, sewage was often disposed of by diverting it into streams which in turn irrigated the town’s outlying fields. The stench in their vicinity was dreadful. However, this did not keep farmers from pasturing their cattle on the fields that were contaminated by entozoa (animal parasites living within other animals). Naturally, many of the cattle became ill.

When someone in Carlisle suggested sprinkling the fields with very small amounts of carbolic acid, a newly discovered antiseptic, there was an amazing change. The stench disappeared, the entozoa were destroyed, the animals remained healthy. If carbolic acid could kill entozoa, Lister reasoned, it might possibly also kill germs. It would certainly be worth investigating.

Dr. Thomas Anderson, the Professor of Chemistry at Glasgow University, who had first called Lister’s attention to Pasteur’s work and with whom he now discussed his idea, happened to have a sample of crude carbolic acid. It was a dark, unpleasant-smelling liquid, then little more than a chemical curiosity in Scotland. It had been discovered by a German chemist in the early 1830’s and found use as a powerful deodorant and disinfectant. Occasionally it had been used, more or less haphazardly, as a surgical dressing. Its usefulness as such had been unimpressive.

Lister was not looking for just another wound dressing. His was an altogether different problem. He was in search of a chemical that would kill germs and thereby prevent putrefaction. Any chemical would do. Of course, in killing microbes it would have to be well tolerated by the patient and not damage his tissues. Naturally he would have to be very careful. He would at first use carbolic acid only on patients with compound fractures. Under routine treatment, as then practiced, almost inevitably such patients faced wound infection, with all its dreaded complications. For them there was little likelihood that the new treatment would make things worse. On the other hand, it might help. It was their only chance.

The first patient upon whom “antiseptic treatment,” as Lister called it, was tried was a man with a compound fracture of the leg. The trial was a dismal failure. That was in March, 1865. For several months no other patient with compound fracture was admitted to Lister’s wards. He would have had ample opportunities for testing the new treatment on other patients, but he restrained himself with characteristic firmness. He felt he had no right to expose anyone to an unnecessary risk.

On August 12 th, James Greenlee, an eleven-year-old boy, had been knocked down and run over by a cart on the streets of Glasgow. The boy was brought to the Infirmary with a compound fracture of the left leg. The wound was about an inch broad and several inches deep. A piece of lint dipped in carbolic acid was laid upon the wound; the leg was bandaged and splinted and left untouched for four days. When the boy at this time complained of some discomfort, the bandage was removed and the wound examined. The skin around the wound was slightly reddened, but there was no trace of pussiness. And this by the time compound fractures usually had become badly infected! Now, diluted, instead of pure, carbolic acid was applied. After another nine days it had become evident that there was no longer any danger of infection. Carbolic acid was discontinued and replaced by simple water dressings. Six weeks later the boy was cured. He had made a complete and, for those days, very rapid recovery.

Although Lister found the course of the boy’s illness “most encouraging,” he did not doubt that it had been “a favorable case” that “might have done well under ordinary treatment.” In the next case the new treatment ended in semi-failure. The patient survived, but the treatment did not save his leg from amputation.

Three quarters of a year after introducing his new treatment, Lister still had no real indication of its efficacy. In one patient it had failed utterly, in another it had achieved what might be called a partially satisfactory result, and in the only patient in whom it had been apparently successful, the old form of treatment might have been equally good.

Although Lister was burning to know whether he was on the right track, he still would test the antiseptic treatment only in patients with compound fractures. A man less firm might have succumbed to the temptation to try it in other cases. Having decided upon the course to be followed, he stuck by his decision. If no appropriate case presented itself, he would wait. He did have to wait—for eight months. Then, between the middle of May and the end of September, 1866, seven cases of compound fracture came under his care.

The case histories of two of these patients reveal vividly the shocking social and working conditions that prevailed in industrial countries at this time. Both patients, young boys—children of ten and thirteen—were factory workers who had worked at unprotected machinery. The right arm of the younger child had been caught between a fast-moving strap and a shaft. The machine could not be stopped immediately, and for about two minutes the strap continued to cut deeply into the boy’s arm. The other youngster had been struck by the governor of a steam engine and thrown with such force against an iron pillar that he suffered a bad compound fracture of the left thighbone.

All of the patients had been severely injured. Some ran a stormy course while under treatment. None developed an uncontrollable infection. All were spared the anguish of amputation. One can imagine Lister’s elation. The new treatment, he wrote, had more than realized his most hopeful expectations.

In an article that appeared serially in the Lancet between March and July, 1867, he communicated his findings to his medical colleagues. The reception of his discovery was far different from what Lister expected. The majority of physicians paid little attention to it. Hardly any understood the greatness of his concept. It did not dawn upon them that he had made a discovery of fundamental importance—one that was destined not only to revolutionize surgery but to help solve the mystery of infection. They did not understand that they were standing at the threshold of a new era in medicine. The most favorable impression, as expressed editorially by the Lancet, was that in carbolic acid a possibly effective substance had been found for the treatment of compound fractures. Less well-inclined men, like Sir James Simpson, the famous discoverer of chloroform narcosis, were not willing to acknowledge even this much. Carbolic acid, said Simpson, had been used before as a surgical dressing. What contribution then, if any, had Joseph Lister made? asked Sir James. Even so clever a man as he did not comprehend that Lister had discovered a new principle: that germs are a cause of disease. Lister was experiencing the fate of many a genius far ahead of his times. His contemporaries were not able to follow the grandeur of his thought.

Others followed Simpson in attacking Lister. Some repeated the accusation that in advocating the use of carbolic acid Lister was little more than a plagiarist decking himself out in stolen feathers. Others, like Dr. James Morton, a former colleague at the Glasgow Royal Infirmary, held the germ theory of disease up to ridicule. “It is a fearful idea . . . wrote Dr. Morton, “that there are formations in nature . . . which are constantly in readiness to aid the grim King in his onslaughts upon frail humanity. Our human nature shudders at the thought. ... We are asked to believe that the air is full of these vicious agents or materials. . . .‘Tis too horrible.’” These unjust attacks hurt Lister deeply. “It is long since I gave up any idea of having any work I might do measured according to its deserts, whatever they might be,” he despondently wrote to his father.

A prophet, it is said, counts for little among his own people. Clearly this was not so in Lister’s case. He found his greatest admirers and most enthusiastic followers among his immediate associates—in the devoted band of young medical men on his staff, in his house surgeons, clerks, and dressers, and in his students. Above all, he found support in Syme, the great master whom he looked up to in veneration.

Outside of this small group he found little acclaim at home. Most English and Scottish surgeons were totally indifferent to his work. Their indifference affected him almost more deeply than the animosity of his critics. Abroad, however—especially in Germany and Denmark—the antiseptic principle awakened the interest of leading surgeons. Professor Saxtorph, the head surgeon of a large Copenhagen hospital, came to Glasgow to observe Lister’s treatment of wounds. Professor Thiersch, of Leipzig, one of the most important surgeons in Germany, began using Lister’s method almost immediately after its publication. Other continental surgeons followed their example. All gave evidence of the method’s amazing effectiveness. In Great Britain, especially in London, the antiseptic treatment continued to be ignored.

But Lister was not shaken by the apathy of his countrymen. He knew he was on the right path. He also knew that the antiseptic system was not perfect.

From now on his life was dedicated to its perfection. He tried to find better ways of applying carbolic acid. He experimented also with other antiseptic substances. The use of carbolic acid, he repeated again and again, was not essential to his method. It was just one substance that happened to be a powerful killer of microbes. So far as he was concerned, any other substance that had this property would be satisfactory. The essential objective of the antiseptic principle was to destroy the microbes. Pasteur had used heat to kill germs. Lister had hit upon carbolic acid. This was what his detractors did not understand or did not wish to understand.

There were those who, like Dr. Morton, continued to deny that germs had anything to do with putrefaction and wound infection. To prove his point to them, Lister performed experiments similar to Pasteur’s. Like Pasteur, he used flasks with straight and with bent necks, but instead of putting a solution of sugar into the flasks, as Pasteur had done, he filled his flasks with urine, a liquid that readily becomes putrid when exposed to the air. As in Pasteur’s experiments, the liquid remained unaltered in the flasks with bent necks, into which microbes had been unable to penetrate. In the flasks with straight necks, into which microbes could penetrate, the urine became putrid. Surely this was a clear demonstration of the validity of the germ theory. But again Lister’s opponents refused to be convinced. They did not bother to repeat his experiments—the only scientific approach they could have taken. They simply ignored them.

Why were the English surgeons so generally opposed to the antiseptic system? Probably because it was based on a concept that to them appeared fantastic beyond words. It was one thing for a French chemist who dabbled in biology—most likely a dreamer—to propound an unlikely theory to explain the fermentation of sugar. It was something entirely different for an English surgeon, supposedly a “practical man,” to make this theory the basis for the treatment of wounds. This was going too far. It was totally unacceptable. Obviously, since the man could not be taken seriously, it was best to reject his teaching.

Some thought they should give Lister a chance. They visited his wards to observe his work. Some stayed for a day, some a bit longer. Few stayed long enough. Then they went back home and practiced antiseptic treatment and found it a failure, because they had entirely misunderstood Lister’s ideas, and because they lacked his unending patience, his almost unheard-of attention to even the smallest detail. The antiseptic system, they said, was not for the busy surgeon. It was “impractical.”

In Lister’s hands and in the hands of the few surgeons who practiced it conscientiously and expertly, the results were nearly miraculous. Wound infection was now the exception rather than the rule. Lister’s wards, once the most infection-ridden at the Royal Infirmary, became the most healthy, while those of the three other surgeons—who would have nothing to do with his newfangled ideas—remained as infected as ever.

When Lister published these results, he immediately became involved in a heated controversy with the directors of the Infirmary. His paper, later to become one of his best-known publications, was entitled “On the Effects of the Antiseptic System of Treatment upon the Salubrity [healthfulness] of a Surgical Hospital.” Before the introduction of the antiseptic treatment, he wrote, his patients had suffered from hospital diseases “in a way that was sickening and often heart-rending.” In the first nine months following its full introduction, he had not had a single case of pyemia (blood poisoning), erysipelas, or hospital gangrene at a time when the un-healthfulness of other parts of the same building was attracting the serious and anxious attention of the directors. In the following two years there had been only an occasional case. All this was achieved despite the hospital’s extremely unhealthy location—adjacent to a burial ground—and despite its overcrowding.

Were it “justifiable to institute an experiment on such a subject,” he continued, “it would be hardly possible to devise one more conclusive.”

The directors were furious. They regarded Lister’s article as an attack upon their integrity and upon their management of the Infirmary. They sent an angry rebuttal to the Glasgow Daily Herald and to the Lancet, accusing Lister of unfairness and misrepresentation. They spoke with pride of the improved health and satisfactory condition of the hospital, attributing them mainly to “the better ventilation, the improved dietary, and the excellent nursing to which the directors have given so much attention of late years.” Lister’s introduction of antiseptic treatment was, to them, apparently purely coincidental.

This was to be the pattern for years to come. The majority of Lister’s colleagues paid no attention to his discovery. When they could no longer ignore the fact that wound infection had become almost extinct in hospitals where the antiseptic system was adequately practiced, they gave the credit to everything but Lister’s method. All the while, on their own wards, hospital diseases were taking their heavy toll. Seven years after the first publication of Lister’s work, we still find Sir John Erichsen, Lister’s former chief at University College Hospital, deploring a situation in which the surgeon’s “most consummate skill and most devoted attention are often . . . rendered unavailing.” And still Sir John did not see fit to introduce the antiseptic system on his wards! Nor did most other English surgeons. They admitted that to overcome wound infection was the most urgent medical need of the day. But they continued to shut their eyes to Lister’s results.

During these years, Lister was continually working on the improvement of the new treatment. Every patient was carefully observed and the effect of the carbolic acid on the wound minutely studied. It soon became clear that undiluted carbolic acid was too strong. It irritated the surrounding tissues. In greater dilution it was better tolerated and was just as effective. Next, different kinds of dressings were tried. And so, step by step, with never-ceasing diligence, the antiseptic treatment was perfected.

In April of 1867, two years after he had first started using the new method of treatment in compound fractures, Lister decided to try it in an operation. The patient was a man with a deep-seated tumor of the arm. In the past Lister would have expected the wound to become seriously infected. Two days after the operation Joseph wrote his father that the patient’s arm was “as free from pain, redness or swelling as if it had not been touched.” A week later he was able to report that there had not been the slightest formation of pus in the wound nor redness or swelling of the limb. “Nothing,” he wrote, “could have been more satisfactory.” It was really a most gratifying result.

A few months later Lister had the harrowing experience of having to perform a dangerous operation for cancer on one of his own sisters. He could hope for a successful outcome of the operation only if he were to use his newly developed technique of wound treatment. He went to Edinburgh to discuss the problem with Professor Syme, who advised him to use it. The operation was, understandably, a dreadful ordeal for Joseph. It saved his sister from certain death. After its completion Joseph wrote that he did “not wish to do such a thing again.”

5

“THE MAN MOST CAPABLE”

In the spring of 1869, Syme suffered a stroke. Although he at first made a fair recovery, he soon realized that he would never again be his old self. In July he resigned from the post of Professor of Surgery.

At once Lister’s name suggested itself to many as that of the most appropriate person to succeed him. Certainly many of the medical students in Edinburgh thought so. Immediately after Syme’s resignation became known, they addressed the following petition to Lister, urging that he become a candidate for the post:

Dear Sir, We the undersigned students of medicine of the Edinburgh University and Medical School, beg most respectfully to invite you to become a candidate for the Chair of Clinical Surgery now rendered vacant by the resignation of our venerated teacher, Professor Syme.

We take this step from a conviction that you are the man most capable, from your high attainments and achievements in Surgery, to maintain the dignity and renown which have been conferred upon the Chair and the University by Mr. Syme.

We believe that your researches in various departments of Science, and your contributions to its Literature, have caused your name to stand next to that of Mr. Syme amongst the living Surgeons of Scotland.

Your method of Antiseptic Treatment constitutes a well-marked epoch in the history of British Surgery, and will result in lasting glory to the Profession, and unspeakable benefit to mankind.

We feel sure also, that if you are appointed to this Chair, the benevolence of your character, and the urbanity of your manners, will speedily draw around you a large band of attached and devoted followers.

In such glowing terms these young men expressed, well before their elders, an understanding of the importance of Lister’s researches and of the role antiseptic treatment would one day play. In the long run, they, the young people, the physicians of a future day, were to bring his ideas to acceptance. Lister understood this well, and he placed his hope and confidence in the young.

In August, Lister was appointed Syme’s successor. A few weeks later Lister’s father died. The ties between the two men had been very close. In an obituary notice of his father, written by Joseph at the request of the President of the Royal Microscopical Society, he speaks of him as having been “most unselfish and scrupulously tender of hurting the feelings of others. . . . But the crowning grace of this beautiful character, though it might veil his rich gifts from those not intimate with him, was a most rare modesty and Christian humility.”

Soon after returning from the funeral, the Listers made preparations to leave for Edinburgh. Although he was looking forward to his new assignment, Joseph did not part from Glasgow without regret. He had spent over nine years there—eventful years, during which he had developed ideas that, he was deeply convinced, would finally conquer wound infection. He knew that it would be an uphill fight. Very well, Edinburgh would give him added opportunities to wage the battle.

For more than a hundred years Edinburgh had been the leading English-speaking medical school. Syme had been regarded by many as the foremost British, if not the foremost European, surgeon of the day. As Syme’s successor Lister was bound to attract the attention of many—if not to himself, at least to his work. That counted for everything with him. He had no desire for fame. He wanted to see his work acknowledged.

On November 8th he gave his Introductory Address in the chemistry classroom of the University. The room was packed with dignitaries and students who had come to see the man whose teachings were so controversial. Professor Syme, old and wizened-looking, was greeted by rousing cheers as he took his seat among the audience. And then the new professor arose. He was tall and well-built and, at forty-two, in the prime of life. His features were regular and very handsome. His forehead was broad and clear, his eyes thoughtful, his mouth sensitive and full, his jaw and chin strong and forceful. His brown hair was worn somewhat long, in the manner of the times, and he was clean-shaven except for side-whiskers. He was meticulously dressed in the black broadcloth frock coat, striped dark gray trousers, upright collar and black silk bow tie of the professional man. His voice was low and melodious, his speech slow, deliberate, and somewhat halting. Occasionally there was a very slight stammer. He delivered his address extemporaneously, assisted by a few notes.

If the speaker impressed the audience as being unusual, the setting did so no less. On a table in front of the lecturer there was assembled an array of eccentric-looking glass flasks filled with multicolored liquids—a chemist’s paraphernalia. What relationship could they have to a surgeon’s lecture? What could they have to do with surgery, the art of amputating arms and legs and treating people with gaping wounds? What was this? Was the new professor really not to be taken seriously, as many of his detractors claimed?

After a few words of warm appreciation of Syme, “our old master,” Lister began the main theme of his lecture, the importance of the germ theory of putrefaction in surgery. In lucid, precise language he traced the historical development of the germ theory. He spoke of Pasteur’s “beautiful researches,” and described the Frenchman’s method of experimentation—the use of glass flasks to determine the presence or absence of germs in the air. Then he explained his own experiments on the putrefaction of urine, in which he made use of Pasteur’s flasks, and he demonstrated the changes that had taken place in some of them. He spoke eloquently of his desire to convince them of the truth of the germ theory of putrefaction —the “pole-star” and basis of “a new mode of treatment” that had made surgery “something totally different” from what it used to be. “Injuries and diseases formerly regarded as most formidable, or even hopeless,” he said, “now [advance] quietly and surely towards recovery.”

In closing, he addressed himself directly to the students in the audience. He commended the facts he had presented to their “candid and impartial judgment” and urged them to form their own opinion regarding them. He told them that they were now as competent as they ever would be to draw logical inferences from established facts. “Do not, then, let any authority shake your confidence in knowledge so obtained” were his parting words.

The listeners were spellbound throughout his presentation. They were captivated by his earnestness, his manifest honesty, his conviction of the efficacy of his new method. Many sensed that this was the beginning of a new era in surgery.

On the day following Lister’s Introductory Address, a large number of students assembled in the operating theater of the Royal Infirmary to hear the new professor give his first regular lecture. Ever since his early Glasgow days, Lister’s lectures had been the delight of his students. They were so different from everybody else’s. It was true that they did not help very much in passing examinations, but they always contained something of basic importance—something that was intended to create a better understanding of surgical problems as such. The lectures contained much information about the professor’s laboratory researches—researches on inflammation, on the clotting of the blood, on those mysterious fungi and microbes that were responsible for the fermentation of wine and the putrefaction of urine. Their young professor, the Glasgow students had felt, was one day going to be a great man. In fact, in their eyes, he was already a great man.

His lectures soon became as popular in Edinburgh as they had been in Glasgow. Each year he attracted a class of between 170 and 180 students, who followed his discourse with rapt attention. The Edinburgh students, who had so enthusiastically invited Lister to come to their medical school, never had occasion to regret their step. Lister was an inspiring and fascinating teacher, who cast an almost magic spell over his listeners.

One of these students was Watson Cheyne, a young Scot from the Shetland Islands, who later became Lister’s assistant and, in time, a prominent London surgeon. In October, 1872, Cheyne, then a second-year medical student, had registered for classes in surgery, physiology, and anatomy. There was an interval between his classes, from twelve to one o’clock, during which he did not know what to do with himself. He lived too far away to go home, and he wanted shelter from the biting east winds. Since there was at that time no Students’ Club at Edinburgh, the only alternative was to sit in the general library. “But it was small and crowded with students of all faculties,” Watson wrote, “and there was no chance of a shy youth like myself getting a seat. So it occurred to me that I might as well take out my hospital ticket in October, 1872, as in the following May, which would be the usual time; in going round the hospital I might learn something, and anyway I would get shelter from the wintry blasts between noon and one o’clock.” As a result of this decision, Cheyne encountered Lister. He has left a vivid account of how he fell under the surgeon’s spell:

I shall never forget the first day that I went to the hospital. At twelve o’clock I crossed the road to the Infirmary and found crowds of students hurrying along the lobbies, a good many, indeed, running. I joined the company, full of curiosity, and found that we were going to Lister’s clinical lecture. We ultimately reached the large operating theatre and found it filled with men crowding the gallery and standing at the back and in the gangways; there must have been over 200 there, and they were senior men, for the clinical surgery class was not usually attended till the fourth year. I should think that I was the only one of my year there. Presently a man walked into the arena, sat down on a chair placed on the floor of the theatre, and crossing his legs and putting his right hand on his thigh, he began his lecture. This man was Lister. He had not spoken many minutes before I became fascinated with the subject and could not help seeing the wonderful era that was dawning for surgery. I had my notebooks for the other classes in my hand and I started to take down what he said, and, as he spoke very slowly and clearly and I scribbled very quickly, I was able to take down practically the whole lecture, though, not having learnt any surgery, I did not understand it at all clearly at first. But what a contrast with the lectures on systematic surgery! Very dreary performances full of curious theories about the reactions of the body and inflammation, quite unintelligible to me, evidently something which had to be memorized but nothing to think about. And then at twelve o’clock, simply seeking shelter from the “cauld blasts o’ Auld Reekie,” and not knowing that I had met my fate, I became entranced by the wonderful vision laid before us by Lister.

Is it any wonder that I left the theatre an enthusiast for the profession that I had chosen, and that on lecture days I was one of those who ran? An enthusiast I still remain. On my way home that first afternoon I bought a superior notebook into which, as soon as I got home, I copied out my notes of Lister’s lecture and all that I could remember, looking up the words I could not understand in my text-book on surgery.

Cheyne continued to do this after every lecture during the winter session of 1872-1873 and for a part of the following summer. Later he presented his notebook to the Royal College of Surgeons in London, where it undoubtedly still remains.

Although the majority of Lister’s students became firm believers in the germ theory and antiseptic treatment, there were some who remained doubting Thomases. Between the two groups, known as “Listerians” and “non-Listerians,” there was considerable rivalry. The Listerians looked upon the non-Listerians as “lost souls.” The non-Listerians, in turn, considered Lister’s followers crazy, rash, blinded by enthusiasm, and—since Listerians contended that wounds treated according to their hero’s method did not become infected—liars of the first water.

The Old Surgical Hospital (Royal Infirmary), Edinburgh, opened in 1832

The operating theater of the Royal Infirmary was a large, high, bare room covered with the soot and dirt of decades. Undoubtedly it was cleaned from time to time, but the effects of such efforts were hardly recognizable. The room got its light through one large north window, which no one had ever seen opened. There was room for several hundred students, who were seated in ascending semicircles overlooking a large groundspace whose wooden, bloodstained, worn floor was sprinkled with sawdust. Here, seated next to the operating table—an ordinary kitchen table—the professor delivered his lectures. There was also a blackboard, which Lister used quite frequently, though he was not a very good draftsman.

Three or four patients were presented at each lecture and their illnesses discussed by Lister. Sometimes he would perform an operation on one of them—in street clothes, as was the custom. He took off his coat, rolled up his sleeves, and had a towel pinned to his chest. Then he washed his hands in a diluted solution of carbolic acid. (Most surgeons in those days washed their hands after an operation, not before one.) When the patient had been anesthetized with chloroform, one of the assistants started pumping the carbolic acid spray, known as the “donkey engine” because of its long handle. Soon the patient, the operator, and the assistants were enveloped in clouds of carbolic acid.

No attempt at showmanship was ever made. Lister never aimed at impressing his spectators through a display of daring or brilliance. He operated slowly, carefully, deliberately. In an emergency, his dexterity and rapidity could be amazing. An air of solemnity pervaded the whole scene. The professor never indulged in a witticism or in joking remarks. Once, during the performance of an operation, he noticed some onlookers talking. Turning to them, he said gravely, “I ask you to remember this place is holy— more so than any church. Silence, if you please.”

Operations can at times be harrowing experiences for even the most seasoned surgeon. Unexpected and unforeseen complications, the inattention or clumsiness of an assistant, begin to fray his nerves. A coworker’s false move finally sets off an angry explosion. Lister was never known to react in this way.

A look of reproach, a quiet “Really, Mr.———, I am surprised at you”—that was all. Those to whom this happened probably never forgot the incident.

After completing an operation, Lister applied the dressing himself and from then on, on his daily hospital rounds, he personally inspected and, when necessary, changed the dressing. He always did this with the greatest care and gentleness. When he was finished he arranged the patient’s pillows, asked him whether he was “quite comfortable,” gave him an indescribably warm smile, and passed on to the next patient. Outside the hospital Lister was seldom seen to smile. His usual expression was serious, restrained, often slightly melancholy.

His general manner was formal, reserved, even somewhat shy. He rarely addressed his assistants by their surnames alone. It was usually “Mr.———.” Despite their deep attachment and devotion to him, his assistants felt that Lister was surrounded by an almost impenetrable air of aloofness. They had a feeling of awe in his presence.

His patients at the Infirmary, the city’s poor and underprivileged, adored him. With them he lost some of his formality. For them he would have some little jest. With them he could unbend—especially with children. On making rounds one day he came to a little girl who was crying bitterly. One of her ragged doll’s legs had come off. Lister asked for needle and thread and, sitting on the child’s bed, he slowly and solemnly sewed on the leg. The little girl smiled at him. Returning her smile, he moved on. Neither had spoken to the other.

How close children were to the heart of this man who never had children of his own has been related by one of his former students:

In discussing the prospects of an operation that was to be performed on a young child, Lister reminded his listeners that in the case of children the surgeon’s responsibilities were especially heavy. An adult, he said, had the power of submitting to or declining the suggestions of the doctor, and could thus share with him at least some of his responsibilities. “But children are powerless in our hands, and this should make us all the more cautious in anything we undertake to do to their sacred little bodies.” With the rare intuition of a child, a little “street arab” on his wards once said of Lister: “I think it’s the little yins and the auld wimmin he likes best.”

When presenting a patient during a lecture or on hospital rounds, Lister always referred to “this poor man,” “this good woman,” “this little chap.” He carefully avoided speaking of “this case,” as physicians, unthinkingly, are often accustomed to do. The humanity and dedication with which he approached even the humblest patient once prompted one of his students to say that he believed Lister thought every patient was sent to him “with God Almighty’s visiting card.”

The death of a patient deeply affected him. He reviewed the course of the patient’s illness and the treatment he had received, searching for errors he might have committed. He did this publicly, in the presence of his students and assistants, never attempting to conceal a mistake he might have made.

Not long after coming to Edinburgh Lister was called to attend a patient who obviously came with “God Almighty’s visiting card.” The patient, Queen Victoria (“Queen . . . by the Grace of God”), was suffering from a painful abscess in the pit of the arm. She was staying at Balmoral Castle, in the Scottish Highlands, and there Lister performed the operation. With his accustomed gentleness he operated upon the august patient. Her Majesty long remembered him as a gentle man who had “most pleasantly performed ... a most disagreeable duty.”

Undoubtedly the Queen’s personal remembrance of him, no less than his prominent position in scientific circles, was responsible for a letter from her private secretary, Sir Henry Ponsonby, informing him that the Queen had been “dreadfully shocked” at the details of some of the “practices” of vivisection and that she was “most anxious to put a stop to them.” Sir Henry “feared” that the “unnecessary and horrible cruelties” which had been “perpetrated” would continue to be inflicted on the lower animals. The letter ended by saying that the Queen appealed to him [Lister] “to make some public declaration in condemnation of these horrible practices.”

His answer to Sir Henry is one of the most dignified, pertinent, and biting rebuffs ever given the well-meaning, but unrealistic opponents of experiments on animals:

Your letter conveying Her Majesty’s desire that I should make some public declaration against vivisection, was placed in my hands on my return from the Continent.

I should deeply regret that I cannot see my way to complying with this request, were I not persuaded that my doing so would not promote the real good of the community, which I know to be Her Majesty’s only object in the matter. And I feel bound to endeavor to express shortly the reasons for my opinion.

With this object I can hardly do better than begin by saying that I have myself often performed experiments upon the lower animals, and that, if I have been privileged in my professional career to do anything for the good of my fellow men, more is to be attributed to those experiments than to any other work in which I have engaged. When they were performed without chloroform, as has not infrequently been the case, they have been done at a very great sacrifice of my own feelings; but the greatness of the object in view has appeared to me to override such considerations.

That man is justified in causing the death of the lower animals for his own advantage is allowed on all hands. Animal food is not indispensable to man, as the example of the vegetarians teaches; yet its use is all but universal, and is indeed abundantly sanctioned by Scriptural authority.

The infliction of pain upon the brute creation is also allowed by all to be justifiable when some important human interest is supposed to be served. If, for example, a valuable race horse were affected with a tumor, not growing from any vital part or causing any inconvenience to the animal, but disfiguring it or interfering with its successful running, I doubt whether any one would be found who would object to a veterinary surgeon being called in to remove the growth; although the pain involved in the operation would be inflicted, not for the good of the horse at all, but merely for the sake of the pride or purse of the owner. Or to take another more cogent example, which the great importance of the subject compels me to adduce. All oxen and the great majority of our male domestic animals, such as sheep, pigs, and horses, have been subjected to an operation involving exquisite agony in its execution, and often severe pain from subsequent inflammation in the wound, the object being to make them more easily fattened for slaughter, to render them more patient and docile servants. Compared with practices like these, that which has received the odious appellation of vivisection is justified by far nobler and higher objects; not the ministering to the luxury or comfort of a generation, but devising means which will be available throughout all time for procuring the health of mankind, the greatest of earthly blessings, and [the] prolonging of human life.

When therefore I have had placed before me on the one hand the reasonable prospect of promoting these great objects, and on the other my own unwillingness to inflict pain, I have felt bound to give the greater weight to the former. . . .

Indeed the term cruelty seems to be altogether misapplied in the discussion of this question. An act is cruel or otherwise, not according to the pain which it involves, but according to the mind and object of the actor. . . . Even the fox-hunter is not commonly regarded [as] cruel; because the protracted bodily suffering of increasing fatigue combined with the utmost mental torture which a fox can be supposed capable of enduring, not to mention the final act of worrying by the dogs, are not the objects which the hunter has in view, but if he ever thinks of them at all, are regarded as entirely secondary to the gratification of himself and his friends. But surely those who regard this amusement as justifiable are strangely inconsistent if they brand with the epithet cruel the man who performs an experiment upon an animal at great sacrifice to his own feelings and with every care to render the pain as slight as is compatible with the high object in view. . . .

It is sometimes said that, although such experiments may be needful and right for the purpose of discovery, they are not justifiable for the demonstration of truths already ascertained. It would, I believe, be very wrong to draw any such line of distinction. To take a single instance; to debar the student of medicine from having his eyes opened to the truth of the circulation by seeing the blood coursing through the vessels of the living web of the frog’s foot, would be undoubtedly a mistake; for no amount of verbal teaching could do for him what a glance through the microscope at that sight at once effects. . . .

I am therefore clearly of the opinion that legislation on this subject is wholly uncalled for; while any attempts of that kind might prove very injurious by checking inquiries calculated to promote the best interests of Her Majesty’s subjects.

Thus Lister, the most humane and considerate of human beings, declined emphatically to comply with the Queen’s request. (One must not forget the period at which this was done nor the person he chose to oppose.) Although Lister had so strongly opposed laws that would prohibit experiments on animals, antivivisection legislation was enacted by Parliament.

Life in Edinburgh during these years was pleasant though strenuous for the Listers. They had bought a house in fashionable Charlotte Square, and Joseph had set aside a room as a laboratory. Here, with Agnes’s assistance, he spent long nights continuing his researches on bacteria and fungi. Bacteriology, which has since developed so amazingly, was then in its earliest stages, and Lister was faced by many technical difficulties. The notes of his experiments, which fill many hundreds of pages in his “commonplace books” (notebooks), are eloquent testimony to his inexhaustible perseverance. After a full day of teaching, hospital work, and university duties, he would often not leave the laboratory before four or five in the morning. Agnes shared these hours with him, filling page after page with notes on his experiments.

If the nights were long, the days were hectic. A passage from a letter which Agnes wrote to one of Joseph’s sisters describes what she called “a busy day”: “Joseph has only just come from the hospital at 4:15! and we are going to have lunch! He has had to perform two amputations at the Infirmary and on coming home finds people waiting for him, . . .who he is seeing now without having had lunch. He has an operation in private at 4:30! and three patients to see afterwards. . . . Joseph had an operation here before going to the hospital. . ."

Agnes Syme Lister

But there were also hours of recreation. There were many distinguished scientists at the University whose company the Listers enjoyed. There were outings in the country and trips abroad. Since his childhood days, when he had gone on long country walks with his father, brothers, and sisters, Joseph had had a keen interest in botany and bird lore. He retained this love of the outdoors all his life.

6

“A STEEP AND THORNY PATH”

During his last year in Glasgow, some foreign and a few British doctors had visited Lister’s wards. Now more surgeons were coming to Edinburgh—mainly from France and Germany and occasionally even from faraway America—to observe his new method. All were much impressed by what they saw. Dr. Schultze, a German surgeon, who had been sent to Edinburgh by his chief, the famous Professor von Volkmann, reported that since Lister’s appointment at the Royal Infirmary two years earlier there had not been a single case of pyemia, hospital gangrene, or erysipelas on his wards. In contrast to the “good surgical stink” encountered in most surgical hospitals (an odor so fetid and penetrating that only the most hardened could take it), the air on Lister’s wards was, in the opinion of the German visitor, “very good.” Dr. Schultze was all the more impressed since he had found the Infirmary to be an “old, soot-grimed building” dating from the reign of George II. At the time of the doctor’s visit, in November, its wards were “already appreciably cold. The frugalness of their equipment suggests almost an air of poverty.”

After seeing the remarkable results of the antiseptic method on Lister’s wards, Dr. Schultze was astonished to find that Lister had but few followers in London. The prominent surgeons there would have nothing to do with his method. They felt its results were not better than those of any other method; they found the whole affair too complicated. They voiced no specific objections to it—in fact, they were often not familiar with its details, nor were most other British surgeons.

In August, 1871, Lister gave the Address in Surgery at the annual meeting of the British Medical Association in Plymouth. He regarded it a “high honor” to have been selected to deliver it, he told the assembled doctors, and he felt it his duty to endeavor, if possible, to give an address worthy of the honor. With this object in mind, he had decided against attempting a general review of surgery, as this was so often done on such occasions. Rather, he was going to bring before his colleagues “a subject which, though in some respects a special one,” was calculated “to revolutionize almost every department of surgical practice.” He was referring, he said, to the antiseptic system of treatment.

At this distant date one can still almost visualize the audience sitting up in their chairs. At once it became clear that the lecturer was not going to pull any punches—and he didn’t. Among the causes that had previously interfered with the general acceptance of the antiseptic system of treatment, he told his listeners, by far the most prejudicial was the doubt of its fundamental principle—a doubt instilled by various authors who opposed the germ theory of putrefaction. These authors, supposing themselves to be advocating the cause of truth, not only supported the side of error but unconsciously inflicted an amount of material evil upon their fellowmen that mere speculative opinion was seldom able to produce.

Another great cause of failure and consequently of dissatisfaction with the system, he said, was the lack of practical initiation into the treatment. Mere description seemed to him inadequate to convey a clear idea of the method that had of late greatly improved the “simplicity and efficiency” of antiseptic treatment. It was therefore his intention to discuss first the theoretical basis of the treatment and then to demonstrate the chief means he was now using and his method of using them. Finally, he would state some facts which he hoped his listeners would regard as sufficient evidence that by such means it was possible to obtain, easily and securely, results that the surgeon could not possibly achieve without them. With statements such as these Lister, despite his apparent moderation of tone, was undoubtedly taxing the indulgence of his audience. But more was to come.

In presenting evidence for the correctness of Pasteur’s germ theory of putrefaction, the theoretical basis of his new treatment, Lister would limit himself, he said, to a few facts and “avoid all doubtful disputations.” He described Pasteur’s experiment of boiling a putrescible liquid in a flask with a drawn-out, contorted neck, and he related how he himself had repeated this experiment. He expressed his regret that he had not been able to bring his flasks all the way from Edinburgh to Plymouth, mentioning that the flasks had already made “one perilous journey” when he took them from Glasgow to Edinburgh, “nursing them carefully during the railway journey, to the amusement of [his] fellow travelers.” He went on to declare that from the flask experiments he had produced evidence that the putrefactive changes which took place in the flasks were “occasioned by particles of dust suspended in the atmosphere, but not by the atmospheric gases.” This was not “a matter of theory” but was “an inevitable inference from fact,” or, in other words, “a truth.” Then, turning to the chairman of the meeting, Lister spoke words that must have made his audience gasp: “I confess, Mr. President, I am ready to blush for the character of our profession for scientific accuracy when I see the loose comments sometimes made upon this experiment; and I am tempted to doubt whether some of the commentators can have enjoyed the advantages of sufficient education either in chemical physics or in logic.” These were strong words from a man as reserved as he.

After further discussion of the germ theory and its importance as the basis of antiseptic treatment, Lister demonstrated his technique and discussed some case histories. In conclusion, he reminded the assembled doctors that hospital diseases had become almost extinct, not only on his own wards but also on the wards of other surgeons who had introduced rigid antiseptic treatment in their hospitals. He told his listeners, not without bitterness, that when he considered the apathy with which such results had been received “in many quarters,” he could not “avoid being reminded of the language of Macbeth:

‘Can such things be, 

And overcome us like a summer’s cloud 

Without our special wonder?’ ”

Lister did not hesitate to predict that the antiseptic principle would certainly be ultimately recognized as the most important of all principles guiding the practice of surgery. “And the sooner our profession is aware of this,” he added, “the better it will be for suffering humanity.”

His address apparently made little impression upon his colleagues. Commenting on it editorially, the Lancet said that nothing new had been advanced in support of the antiseptic principle and added facetiously that “disbelievers in the marvelous efficacy of carbolic acid could not fail to notice that with every public appearance Professor Lister’s solutions become weaker and weaker, while his faith appears to grow more and more.”

For many years to come, Lister had to contend with such indifference and ridicule at the hands of the English surgeons. He almost despaired of seeing them accept his ideas.

Two years after Lister’s address at Plymouth, Dr. John Wood, Professor of Surgery at King’s College, London, gave the Address on Surgery at the British Medical Association’s annual meeting. After discussing various current surgical problems, Dr. Wood went on to say that pyemia, septicemia and erysipelas were undoubtedly the “greatest troubles of modern surgery.” Without their “baneful” influence the success of the surgeon’s improved methods would be enormously improved. By their occurrence the best-laid plans “went wrong” and might result in the death instead of the cure of the patient. When, therefore, a system of dressing wounds was presented that offered a means of avoiding “these terrible enemies,” it was the “bounden duty” of the surgeon to give it a fair and full trial. Such, said Professor Wood, was the antiseptic system of dressing wounds, a method that had been “originally” developed by Dr. Lemaire in France and given a great impulse in Great Britain by “that talented surgeon,” Professor Lister. (Again we hear the voices of those who denied Lister the credit for having discovered a new principle.) For two years, Dr. Wood had, in common with many London surgeons, given this system, he hoped and believed, a fair trial. He had employed solutions of carbolic acid and of other antiseptic substances, but without the “elaborate attempts” to exclude the unpurified atmospheric air which Lister considered essential.

As an “experimental and scientific method of research,” Wood had the “highest possible respect” for Professor Lister’s system. According to Lister’s theory of germs, it was consistent enough; but as a practical method, he said, he had found it wanting. Of course, he had had good results in “some cases” treated by Lister’s method, but, all in all, it was no better than other methods then in use.

Lister did not leave Wood’s statements unopposed. In a letter to the editor of the Lancet, he pointed out that he was attaining “with greater constancy than ever before” the entire exclusion of putrefaction from his wards. Why Mr. Wood should have obtained results so widely different from his he would have to leave to the readers of the Lancet to infer. He wanted merely to remark that, of the many strangers who had witnessed his practice since Wood’s address was given, not one appeared to have had any hesitation in arriving at the true explanation.

This pattern was to persist for many years: the majority of the English surgeons remained skeptical; the foreign surgeons continued to be enthusiastic. In the spring of 1875, at the invitation of his German admirers, Lister visited some of the German hospitals that had introduced his method. Generally, its results had been equally gratifying. “Hospital diseases” had lost their dread; they were fast becoming nearly extinct. Everywhere Lister was received enthusiastically. Under the caption “Professor Lister in Germany,” the Lancet reported: “The progress of Professor Lister through the University towns of Germany, which he is visiting chiefly, we believe, with a view to inquire into the mode in which the antiseptic treatment is carried out on the Continent, has assumed the character of a triumphal march.”

In Munich the Listers were greeted on the morning of their arrival by the prominent surgeon Professor von Nussbaum, in evening clothes, carrying a bouquet for Mrs. Lister. In the evening there was a big banquet in Lister’s honor, attended by almost the entire medical faculty of the University and by many government and municipal dignitaries. A delegation from the student body expressed its “esteem and high appreciation” for the originator of the antiseptic treatment.

In Leipzig, where Professor Thiersch, Lister’s first German follower, held the Chair of Surgery, Joseph was given the same enthusiastic reception, on perhaps an even greater scale. Again there was a banquet, attended by 300 to 400 persons, with speeches, toasts, and songs, two written in honor of the guest of the evening. And so it went on—from Leipzig to Halle, Berlin, Heidelberg, and finally to Bonn. Everywhere the discoverer of the antiseptic principle was acclaimed with admiration.

Later in the year, at the annual meeting of the British Medical Association in Edinburgh, Lister reported on his medical observations in Germany. He also gave a demonstration of his method on his own wards and in his own operating theatre. “At the conclusion of this interesting demonstration,” wrote the Lancet, “in which all the minutiae of antiseptic surgery were elucidated, and the advantages of this practice fully proved, Mr. Lister was loudly cheered.”

But London held out. “There is less antiseptic surgery practiced in the metropolitan hospitals than ever there was,” said the Lancet in a highly instructive editorial. “Many of the most successful surgeons of the present day have, after a trial more or less prolonged of Mr. Lister’s plan, gradually given it up, and resorted to the older and well-established modes of practice. . . .” And, “after the experience of several years,” the editorial went on, “it is found that the success of the antiseptic system is certainly not greater than that of the ordinary methods, and it is stated to be actually less.”

In speaking of the average surgeon’s attitude toward the germ theory—the “pole-star” of the whole antiseptic system, Lister had once called it—the Lancet had this to say: “Happily, it is no part of the business of the clinical surgeon to bolster up theories, be they good or bad, or to make facts rigidly conform to them. The germ theory may be perfectly well-founded; but nine surgeons out of ten do not much care whether it is or not, so long as they cure their cases and reduce their mortality to the lowest possible degree.” How clearly these sentences reveal, unintentionally, the intellectual chasm that separated the genius of a Lister from the uninspired mentality of the majority of his surgical colleagues! How clearly they explain why the antiseptic system was ineffectual in the hands of those surgeons who— neither knowing nor “much caring” whether the germ theory was well founded or not—were engaged, as Lister had predicted they would be, in a “navigation of hopeless difficulty.”

In 1876 the United States celebrated the one hundredth anniversary of the Declaration of Independence. In connection with the commemoration of this important event, an International Medical Congress was held in Philadelphia, and delegates from many foreign countries were invited. America had come of age, and it wanted to demonstrate to the world what it had achieved.

Lister, accompanied by Agnes, went as the representative of the University of Edinburgh and of the Edinburgh Medico-Chirurgical Society. A trip to America was something of a venture for Europeans in those days, and the Listers looked forward to it with great interest.

As on his honeymoon, twenty years before, Joseph combined professional work with sight-seeing. Around the middle of August, Agnes and he sailed from Liverpool on the S. S. Scythia. The Scythia was at that time a showpiece of the Cunard Line. With 4,500 tons displacement, it would be, in today’s terms, a small ship indeed. In 1876 it was regarded as the latest in modern design, with its three masts, one funnel, and watertight compartments that could be rapidly closed in an emergency. It had steam steering equipment that made navigation considerably safer.

At the Medical Congress, where his paper on antiseptic treatment was received with great interest, Lister was honored by being made president of the section on surgery.

Before going to Philadelphia, the Listers had visited Quebec, Montreal, Toronto, and Niagara Falls. After the Congress, they went to San Francisco and, on their way back to New York, they spent some days in Chicago and Boston. In New York and Boston, Lister was given warm receptions by his surgical colleagues. His journey paved the way for the acceptance of antiseptic surgery in the United States and Canada.

Shortly before leaving for America, Lister had given the graduation address at the Edinburgh Medical School. He spoke to his listeners of the high professional standards medicine demanded of its practitioners. He told them that they could cut no corners and warned them against complacency. He made it clear to them that they were probably by no means sufficiently alive to their deficiencies, “for it is an unfortunate property of ignorance that it is ever unaware of its own existence.” He commonly found, he said, that the gentlemen who served under him at the Infirmary as house surgeons were, when they entered this service, “pretty confident” of their powers in the diagnosis and treatment of surgical ailments, but that they grew “more diffident and modest, though immeasurably more capable,” as their term of service drew toward its conclusion.

“In investigating nature” they would do well to bear ever in mind that in every question there was truth, whatever one’s notions might be. This seemed, perhaps, he said, a very simple consideration, yet it was strange how often it was disregarded. When he was a little boy he used to imagine that prejudice was a thing peculiar to some individuals, but he had since learned that all were under its influence, and that it was only a question of degree. “But let us ever contend against it,” he urged his listeners, “and remembering that the glorious truth is always present, let us strive patiently and humbly to discover it. . . .” Lister ended his address with the following passage, so characteristic of his high ideals:

Gentlemen, it may seem to you that these imperfect pieces of advice indicate to you that there lies before you a somewhat steep and thorny path; and truly, if we had nothing but pecuniary rewards and worldly honors to look to, our profession would not be one to be desired. But in its practice you will find it to be attended with peculiar privileges; second to none in intense interest and pure pleasures. It is our proud office to tend the fleshly tabernacle of the immortal spirit, and our path, if rightly followed, will be guided by unfettered truth and love unfeigned. In the pursuit of this noble and holy calling I wish you all God-speed.

A few months after his return from America, some of Lister’s medical friends in London sounded him out to see if he would be willing to accept a professorship at King’s College Medical School. King’s College had been founded by the Church of England as a rival to the “Godless College in Gower Street” (University College). King’s College Medical School, in contrast to its competitor at University College, was small and comparatively undistinguished. When, early in 1877, old Sir William Fergusson, the Professor of Clinical Surgery at King’s, died, some of the King’s men hoped to add luster to their institution by having Lister join its staff.

Lister, who some thirteen years before had applied unsuccessfully for a professorship at University College, was interested in his friends’ suggestion. He told them, however, that he would go to King’s only as Sir William’s successor, a post for which another man, Dr. John Wood, was also competing. Wood’s claims were good. He was an accomplished surgeon, and he had long been connected with King’s.

When Lister’s students heard of these negotiations, they addressed a memorial to their revered professor, begging him not to leave Edinburgh. This memorial, written in glowing terms, was presented to Lister in his classroom at the Royal Infirmary. Apparently touched and carried away by the devotion of his students, Lister gave an impromptu speech in which he said that he regarded the Edinburgh Chair of Clinical Surgery “as so superior in efficiency to any corresponding position at present existing in London” that no consideration would induce him to exchange the one for the other. And, in comparing the methods of teaching clinical surgery in Edinburgh and London, he called the London method “a mere sham.” It was an unfortunate term that was to cause him much embarrassment.

The speech, given on the spur of the moment, and not intended for publication, was reported in the London and Edinburgh newspapers. It became the occasion for a scathing attack upon Lister by the Lancet, whose editorial writer accused him of regarding his professional colleagues in London “as only unsubstantial shades and showy shams. . . .”

Lister immediately wrote to the Lancet, saying that he had in no way intended insulting any London teacher and that his remarks referred purely to the methods used in the two schools. It was to this alone, he wrote, that his remarks had reference, and he hoped the Lancet's readers would see that he had been “neither arrogant nor unjust.”

The negotiations between Lister and King’s College Medical School were continued. Since Lister would accept no appointment other than that of Professor of Clinical Surgery, and since Wood’s claim to the post could not be disregarded, the college’s medical council was in a difficult situation. By creating a second chair of clinical surgery, and appointing Wood to the one chair and Lister to the other, a solution satisfactory to both men was finally found.

At the end of June, 1877, Lister gave up his Edinburgh posts. He gave his last lecture at the end of the summer term. He made his last rounds at the Royal Infirmary before going on his summer vacation. There were no official farewells, no speeches, no testimonials.

Twenty-four years before, he had first come to Edinburgh, young and unknown. After an interlude at Glasgow, he had returned in middle life, a well-known, though controversial, figure. Now, at the age of fifty, he was leaving Edinburgh for good. His name was familiar to surgeons the world over. To some he was the originator of a new era in surgery-one of the great surgeons of all time. To others he was little more than a crank.

In going to London, Lister was obviously making a sacrifice. He was giving up a professorship at one of the most renowned medical schools in the world for one at an unquestionably second-rate school. He was also leaving a city in which his work had found recognition to go to one in which it was, to put it mildly, viewed with skepticism. Although we do not know, authentically, Lister’s motives for going to London, it is very likely that he went because he was rejected there. Not until London, the hub of the world, accepted the antiseptic system could he be sure of its ultimate acceptance. It is certain that he was not in search of fame nor fortune. Convinced as he was of the superiority of the antiseptic treatment over all other methods of treating wounds, he felt it his moral obligation to do everything in his power to ensure its acceptance—for the sake of suffering humanity. If he could let the London surgeons see for themselves the results of his method, he would surely win them over. To accomplish this, no sacrifice was too great.

7

"THE MASTER SURGEON”

On the afternoon of October 1, 1877, the medical world of London turned out in force to hear the new Professor of Clinical Surgery at King’s College give his first lecture. In the audience that filled the large auditorium to capacity were some of England’s most prominent scientists.

In the hope of saying something which “should have interest, and, if possible, even instruction, not only for the student, but also for the eminent men whom [he] had the honor to see around him,” Lister said that he had decided to report on some of his recent investigations on fermentation, more specifically on the fermentation of milk.

It did not take long to see that the lecturer had overestimated the mental caliber of the London medical students. In contrast to their Edinburgh colleagues, who some eight years before had followed his “Introductory” with rapt attention, the London students were bored, and they did not hesitate to make this clear. They mooed when Lister described the experiments he had performed in a cow barn. They laughed and said “Tut-tut” when he mentioned the dairymaid who had assisted him. They shuffled their feet. They reminded him, under their breaths, that it was teatime—time for him to stop. They thought they were being very funny. It was a disgraceful performance.

The medical practitioners, too, were uninterested. They hadn’t come to listen to a dissertation on the fermentation of milk. They wanted to hear about “practical” things. They thought the lecture inappropriate and difficult. Was this the right kind of man, they asked themselves, to instruct would-be doctors of medicine? They hardly thought so.

The students were apparently of the same opinion. Only a handful attended Lister’s lectures—ten or twelve at the most—and then only irregularly and out of curiosity. They did not care about general principles. They wanted to be coached for their examinations. For years to come, Watson Cheyne, who had followed Lister to London, attended the lectures regularly to add one more listener to the class. Lister was deeply disappointed and mortified. To have so few students after his large classes at Edinburgh was to him a “humiliating experience.”

Besides Watson Cheyne, Lister had brought three other men with him to King’s. For them, too, the early days in London were a trying time. They were well received by the other young assistants, but they were unhappy when they saw the total indifference with which their new colleagues regarded their hero and his teachings. No one at King’s showed the slightest interest in antiseptic surgery.

Relations with the nursing staff were less cordial. The nurses, Sisters of St. John, resented the newcomers. In the past the Sisters had had pretty much their own way. They were more of a religious sisterhood than a nursing staff—more interested, it seemed, in the spiritual than in the physical well-being of their patients. They had developed rigid rules and regulations which they were unwilling to change.

When he came to London, Lister had had to leave several of his chronic cases at the Royal Infirmary in Edinburgh. The hospital’s managers soon decided to discharge them. When Lister heard of this decision, “his look of incredulity,” one of his assistants, Dr. John Stewart, tells us, “changed to one of sorrow and honest anger. ‘It is an infamous shame!’ he said.” This was the strongest expression Dr. Stewart ever heard Lister utter.

At Lister’s suggestion, one of these patients, Lizzie Thomas, a young servant girl who was suffering from a large tuberculous abscess, was brought down to London to be admitted to King’s College Hospital.

On a cold, bleak morning at the end of October, Lizzie arrived. She had been transported in one of the baskets in which patients were carried to and from wards at Edinburgh Infirmary. Before she could be admitted, the Sister in charge had to be notified. To Dr. Stewart’s dismay, the Sister refused to admit the patient because she did not have the proper admission papers! The patient, the Sister ordered, would have to wait until the secretary had drawn up the necessary documents. He was not expected at the hospital for another two hours.

Dr. Stewart could not believe his ears. He begged the Sister to allow Lizzie to be taken in. After traveling all night, she was tired and cold. The only response to his plea was a haughty reprimand for his “irregular” behavior. In vain he pleaded ignorance of the rules; in vain he stressed that he had Professor Lister’s permission to admit the patient. The Sister would not be swayed.

Furious, the young doctor finally proceeded, with the help of a porter, to carry Lizzie upstairs to his ward. There, a Sister placed herself before the closed door to bar the way. Other Sisters came to the aid of their colleague. In reply to their question whether he was not ashamed of his “scandalous conduct,” Dr. Stewart told them that he was not, adding that there would be a scandal shortly, for if they did not take his patient in and put her to bed, he would put her there himself. Apparently he looked “as roughly” as he spoke, for resistance gave way and the poor girl was put to bed. But she was, in the doctor’s words, a “speckled bird” for many a day.

The other “chronics” were transferred to a nursing home in Edinburgh and cared for at Lister’s expense.

The senior surgical staff at King’s received Lister, if not with open arms, at least with a degree of friendliness. Dr. John Wood even consented to have Lister supervise the antiseptic management of two of his own operations. Although the results were excellent in both cases, Wood was not convinced that antiseptic treatment was really necessary, at least not in England. In Germany, from whence, he said, came Lister’s fame, it was maybe different, for the Germans were “dirty people.”

Soon after coming to London, Lister performed an operation that raised quite a stir. A man had been admitted to his wards with a broken kneecap. The patient was greatly hampered by the injury, and Lister decided to open the knee joint and wire the two fragments of the kneecap. It was a novel operation, probably the first of its kind. Some surgeons thought it unjustifiably daring. It would, in pre-Listerian days, unquestionably have been so. No one would have dared to open a knee joint, or for that matter any other joint, for fear of infection. One prominent London surgeon went so far as to say that when the poor fellow died it would be proper to arrest “that man” on a charge of manslaughter. The “poor fellow” didn’t die. He got well. And in the next few years Lister performed six other equally successful operations for the same condition.

Less vicious, but equally rejecting, was the behavior of another well-known surgeon, whose standing joke it was to exclaim, with pretended concern, if anyone entered the operating theatre while he was operating: “Shut the door quickly in case one of Mr. Lister’s microbes comes in!”

Slowly the attendance at Lister’s classes became larger. In time, as many as eighty or ninety students came, and there were always the foreign physicians, some of them prominent men, who crowded the corridors smoking cigars and, much to the students’ disgust, occupied the front rows in the operating theatre. That large parts of Lister’s lectures were often given in German or French, for the benefit of the foreigners, added to the students’ resentment. When Lister heard of their complaints, he told one of his assistants, more in sorrow than in anger, that if the students showed as much enthusiasm as the foreign visitors did, he would see to it that they would no longer have reason to be dissatisfied.

The enthusiasm of the foreign doctors was often quite exuberant. One of these visitors told Lister that he had come all the way from Buffalo because he had heard that his [patients’] wounds healed without becoming pussy. But, “like the doubting Thomas in the Scriptures,” he said, “I would not believe without seeing. And, like Thomas, I’ve seen and I now believe. Buffalo shall hear of this.” The American doctor’s “easy reference, without a prefix, to a New Testament saint . . . caused the caps to stand straight up from the heads of the High Church Sisters of St. John,” Lister’s house surgeon later commented, with apparent relish. “Lister beamed,” he added. “He . . . always liked the expansive manners of foreigners.” There can be no better example of the esteem in which Lister was held abroad than the British Medical Journal’s report of his reception at the International Medical Congress in Amsterdam, at the beginning of September, 1879:

The public meeting of Tuesday was principally devoted to an address by Prof. Lister, in reply to various objections that have been made to the antiseptic system. Professor Lister was received by the whole Congress with an enthusiasm which knew no bounds. When he stepped forward to the desk to open his address (which was delivered, with but few notes, in improvised French), the whole assembly rose to their feet; and, with deafening and repeated rounds of cheers, waving of hats and handkerchiefs, hailed the distinguished Professor of King’s College with acclamations renewed minute after minute, and time after time, as his name was again shouted forth by some grateful and enthusiastic acolyte. This remarkable scene—unprecedented, we imagine, in the history of medical science-continued for some minutes, until Professor Donders, the President, advancing with the distinctive grace and dignity for which he is remarkable, and taking Professor Lister by the hand, as he stood overwhelmed with this magnificent ovation, obtained a moment’s silence, and addressing him said: “Professor Lister, it is not only our admiration which we offer you; it is our gratitude, and that of the nations to which we belong.”

What must have been Lister’s thoughts during this ovation when he recalled the recent attack upon him by William Savory, his eminent London colleague? A month earlier, Savory, whom many regarded as one of the most intelligent London surgeons, had delivered the Address on Surgery at the British Medical Association’s annual meeting. Blood poisoning after operations, Savory contended, could be reduced to a minimum by simply enforcing “strict cleanliness.” There was absolutely no need of resorting to Lister’s complicated and cumbersome method of wound treatment. Lister’s method had not shown results “superior or equal to” those otherwise achieved. In fact, it had “grave drawbacks” that made it sometimes “worse than useless.” With ill-concealed sarcasm, Savory had spoken of Lister’s “now famous plan of treatment” and of his (Savory’s) “truest respect” for its author. If he had “esteemed the practice of Professor Lister less, it would have been easy to offer him the homage of flattery, to congratulate him on his renown.” Could the acclaim of his Amsterdam audience let Lister forget such a rejection in his own country?

But the Savorys were not to have it all their own way. Two largely attended and, in the judgment of the British Medical Journal, “influential” meetings, held in December, 1879, at St. Thomas’s Hospital in London, for the discussion of antiseptic surgery, made this very clear. In his opening remarks, Professor Wood, the chairman, calling antiseptic surgery “a subject of paramount interest,” spoke of it as “a question so momentous that it would be difficult to exaggerate its pressing importance, not only to the profession, but even still more to the public.”

The paper of the evening, given by a senior surgeon of St. Thomas’s, was an enthusiastic tribute to the extraordinary results of Lister’s antiseptic method. “If, with the help of this method,” exclaimed the speaker in closing, “the great joints may be opened with absolute impunity by the surgeon’s knife; if such formerly fatal injuries as gunshot wounds of the knee can be saved amidst the difficulties of an army in the field; if ovariotomy [removal of one or both of the ovaries] be made more successful in the hands of experts, who operate on such cases by hundreds, and what is, to my thinking, more important, the operation rendered safer and more successful in the hands of all surgeons; if, in injuries to the head, in ordinary amputations and excisions, and operations of various kinds, and in compound fractures, the risk to life be not only diminished, but the recovery of the patient marked by a minimum of fever, pain, and suppuration, then a gain has been accomplished for surgery which it is scarcely possible to characterize. . . . And,” he concluded, “I do not know which to admire more—the scientific mind which has grasped a great principle and applied it, or the character of the man who has unswervingly pursued the object of his life, patiently perfecting, one by one, the means adapted to procure the end in view.”

In the discussion that followed this paper, some of London’s most prominent surgeons participated. Some were critical of the results achieved by antiseptic surgery, some were lukewarm in their appraisal of its value, and some were wholehearted Listerians.

Professor Wood pointed out that he had started experimenting with antiseptic treatment soon after Lister’s original publications, in 1867. But his “antiseptic bark,” he said, in true Victorian style, had suffered shipwreck “among the shoals of expense.” The Committee of Management of King’s College Hospital had spent much money in hospital arrangement and improved nursing, and Wood was told that if he persisted in antiseptic experiments he himself would have to furnish the funds. This clearly put an end to his active interest in antiseptic treatment.

After defining the limits of his agreement and disagreement with his “esteemed colleague Professor Lister,” Wood paid Lister the following graceful tribute:

I must take this opportunity of congratulating him sincerely upon the possession of those advantages which have made him so powerful an advocate of antiseptic surgery, and will give him so high a niche in the temple of scientific fame; upon the professional position which has given him the authority; upon the gifts of fortune, which gave him the means; upon the gifts of nature, which gave him, in happy combination, 

“The patient thought, the steadfast will, 

Resolve and foresight, strength and skill,” 

which he has laid upon the altar of suffering humanity.

Others spoke in the same vein. The distinguished Sir James Paget, one of the finest English surgeons, after enumerating what he believed to be the advantages and limitations of Lister’s method, declared that of all the achievements of surgery during the last thirty years he regarded the reduction of the risks of operations as by far the most important; and that “beyond comparison, he who contributed most to it” was Lister.

Dr. Timothy Holmes, for whose handbook Lister, as a young Glasgow professor, had written the two chapters on amputation and anesthesia, contended that though “no convincing proof of the germ theory as applied to living tissues and living phenomena . . . [had] . . . yet been offered,” Lister’s practice would last as long as surgery lasted. “And so long,” said Holmes, “shall we thank him.”

Clearly, a change of attitude was taking place, but there was still much opposition to Lister’s teaching, especially to its theoretical basis. Even Dr. Holmes, who had spoken so warmly of Lister’s “practice,” had said that “no convincing proof of the germ theory . . . had yet been offered.” And then there were those who, apparently accepting the validity of the germ theory, contended that Lister’s meticulous, even cumbersome, method of wound treatment was not really necessary. “Strict cleanliness,” they said, was enough to combat wound infection.

But Lister, Syme, and many other careful surgeons had done their best to keep their wards clean. Their most elaborate attempts at cleanliness had not prevented blood poisoning, erysipelas, and gangrene. “Hospital diseases” had continued to take their toll. The near-miraculous change in these conditions had taken place only after Lister had introduced his antiseptic treatment. Cleanliness was, of course, a necessity, but it was not enough.

Despite the well-meaning, even flattering, tributes paid Lister by some of England’s most important surgeons, the attacks upon him did not cease. Occasionally they flared up with such intensity that Lister despaired of seeing his ideas accepted. As late as four years after the debate at St. Thomas’s Hospital, after an especially bitter attack, he told his house surgeon that he did not believe he would live to see his principles adopted. He was now well past middle age; how much time was there left to him? But even if he himself were not to see the acceptance of his teaching, he was convinced, he told his young assistant, that it would ultimately triumph. It was this unshakable conviction that had given him the strength to persist in his crusade in the face of so much bitter opposition.

Of course he had, over, the years, modified his views. He no longer believed that air-borne germs were the only villains in the drama. There were also germs on the patients’ dressings and on their bedding; there were germs on the hands and clothing of the doctors and nurses; there were germs on the surgical instruments. Germs were at the bottom of the whole sordid affair and they had to be destroyed, wherever they might be found, if wound infection was to be conquered.

Lister had now, in 1884, been in London for seven years—active years during which his colleagues there had often heard him deliver papers before medical societies, had met him in medical consultation, had seen the results of antiseptic treatment on his wards at King’s College Hospital. More or less to their surprise they had found him, after having heard so much adverse criticism of him, a modest, straightforward and sincere man. His presence was beginning to have the effect he had so ardently hoped for: the tide of London medical opinion was turning in his favor. When it finally came, recognition of his work was complete. The Lancet, his old adversary, even went so far as to say that the “great” antiseptic method of treatment had “revolutionized modern surgery.”

Antiseptic surgery had made possible operations that, in the past, no surgeon would have dared even to think of performing. Only two decades before, Sir John Erichsen had proclaimed that the abdomen, the chest, and the brain would be “forever shut from the intrusion of the wise and humane surgeon.” Abdominal operations, said another surgeon, were to be classed among the methods of the executioner! Thanks to Lister’s genius, operations on the abdomen and chest had lost their dread, and in the not too distant future surgeons were to operate on the brain also. Surgery had been transformed totally since Lister, as a young Glasgow professor, had had his great inspiration.

If, in the past, Lister had been the recipient of many distinctions, honors during these years were lavishly bestowed upon him. Innumerable medical societies elected him to membership. Oxford and Cambridge, the universities for which he had not been eligible because of his Quaker faith, conferred honorary degrees upon him. The Queen made him a baronet (he was now Sir Joseph Lister), an honor, in those days, seldom accorded medical men. None of these distinctions made him vainglorious. He remained the same modest, almost diffident man.

He had always shunned publicity and, although he was a celebrity in medical circles, he was long little known to the public. In after years one of his former assistants related how a patient, whom he had wanted to impress by mentioning that he had been house surgeon to the great Sir Joseph Lister, had admiringly said, “Yes, a great man; he must have made a pile of money out of Listerine!” (This is a misconception still held today. Lister had no connection whatsoever with the mouth wash which seems to have been named for him.)

Bust of Joseph Lister, by Brock, in the Royal College of Surgeons of England. 

A replica, in the form of a medallion, is in Westminster Abbey.

Lister was now approaching old age. In 1892, on his sixty-fifth birthday, he reached the mandatory retirement age at King’s College Medical School. At the end of July he gave his last lecture before his students. It was appropriately devoted to a description of the antiseptic treatment of wounds, in the development of which he had spent so much of his life and for whose acceptance he had so doggedly fought.

In December he went to Paris as the representative of the Royal Societies of London and Edinburgh to participate in the official celebration of Pasteur’s seventieth birthday. The ceremony, which took place in the main auditorium of the Sorbonne, was staged with all the pomp and pageantry the French know so well how to display.

To the tunes of a triumphal march, Pasteur entered the great hall leaning on the arm of the President of the French Republic. Awaiting them on the platform were the presidents of the French Senate and of the Chamber of Deputies, the members of the French Cabinet, and the foreign ambassadors. Present also were the delegates from the French Institute and the Academy of Medicine and from all the great scientific societies. It was indeed a brilliant assembly that had come to pay homage to France’s great son.

When Lister was called upon to address the gathering, he was enthusiastically applauded by the audience. On the conclusion of his address, Pasteur arose and embraced him. It was the culminating event of a long friendship—one that had begun nearly nineteen years before, when Lister had written to Pasteur, calling his attention to the antiseptic treatment of wounds, which was based upon the Frenchman’s research on microorganisms.

Some months after the Paris celebration, in April of 1893, the Listers went to Rapallo, one of their favorite resorts on the Italian Riviera. They had been there for a few days when Agnes suddenly had a shaking chill. A hastily called physician diagnosed pneumonia, a disease for which there was no effective treatment in those days. Soon it became clear that Agnes was dangerously ill. On the fourth day of her illness, as Joseph and the doctor were helping her change her nightgown, she suddenly collapsed and died within minutes in her husband’s arms. She had been aware of the seriousness of her condition and had dictated farewell messages to her friends. Lister took her body back to England.

The death of his wife was a blow from which Lister never fully recovered. The joy of life was irrevocably gone. Agnes had been his steady companion and helpmate. She had shared his interests and had taken active part in his work. She had sat by his side during the long nights he spent in the laboratory, taking notes and recording the results of his experiments. She had accompanied him on his many journeys. She had shared with him the trying years of his struggle for recognition, and she had participated in his success. She had been his “alter ego.”

With her death, Lister became a lonely man. There were no more social gatherings at his home, and he retired more and more from the company of others. At the end of the summer of 1893 he was relieved of his surgeoncy at King’s College Hospital. At the same time he gave up private practice. “Dear surgery,” as he wrote to a friend, was for him a thing of the past. So was, for the most part, research. He spent less and less time in the laboratory. His “commonplace books” contain few entries during the following years. There are none between 1896 and 1899. The last entry was made on July 21, 1899. It refers to investigations that others were to carry out for him.

Retirement from active work did not mean that Lister no longer took an interest in scientific problems nor that he disappeared from the public eye. In May of 1894 he visited Glasgow, for the first time in many years. His reception was enthusiastic. At the end of an address, given on invitation of a students’ medical society, the students joined hands and sang “Auld Lang Syne.” They unyoked the horses from his carriage and pulled the vehicle through the streets to the house in which he was staying. On the doorstep he addressed a few words of farewell to them.

In the following year he received the high honor of being elected President of the Royal Society; a year later he was made President of the British Association for the Advancement of Science. In his Presidential Address to the latter body (On the Interdependence of Science and the Healing Art), he presented a masterly description of the role pure science had played in the development of medical practice during the last fifty years.

He spoke, among other things, of Pasteur’s work on fermentation and of the great influence it had had upon surgery. Although he had often been asked to speak of his share in this matter before a lay audience, he had always refused to do so, partly because the details were so entirely technical, but chiefly because he had felt “an invincible repugnance to what might seem to savor of self-advertisement.” Now, since he had left the practice of his “dearly loved profession” to younger men, the latter objection was no longer valid.

Earlier in the year he had again been in Paris to attend the burial of Pasteur. He was experiencing, with ever-increasing frequency, the sorrow that comes with life’s later years: the departure of the friends and associates of a happier period.

But there still were many living ties to the past. On the occasion of Lister’s elevation to the peerage in 1897, no less than 130 of his former house surgeons, clerks and dressers, many of whom had come to London from the far corners of the earth, assembled at a dinner to honor him. It was the first time that a surgeon had been created a Peer of the Realm. He was now Joseph, Baron Lister. That their beloved “Chief,” as they had always affectionately called him, was the recipient of this singular distinction was to his former students and associates a cause for great rejoicing. When his health was proposed at the dinner, they drank the toast, in their exuberance, with “Highland Honors,” each guest standing with one foot on his chair and the other on the dining table! The second part of the ceremonial—shattering one’s empty glass by tossing it over the left shoulder onto the floor, so that it may never again serve for any less worthy toast—they omitted only out of respect for the “southern surroundings.”

As the years went by, Lister became more and more of a recluse. Waning of his physical stamina contributed to his desire to be alone. He still enjoyed the company of his closest relatives and of a few of his old friends, but he appeared in public only upon rare occasions. Two such occasions were the ceremony connected with his receiving the Freedom of the City of Edinburgh, in 1898, and his delivery of the Huxley Lecture, the last of his great public addresses.

Periods of ill health became more frequent and his absences from London more prolonged. Buxton, a spa in the English Midlands, whose bracing climate restored some of his old vigor, became one of his favorite resorts. Here, in the summer of 1903, when he was seventy-six years old, he had an unexplained serious illness (he himself believed it to be a stroke) from which he never recovered fully. It left him with a sensation of extreme, hardly tolerable physical and, at times, mental weakness. The man who, in his prime, and for many years thereafter, had been able to work effortlessly for eighteen and twenty hours a day was now exhausted by even slight exertion. His mental powers did not fail him, but mental effort left him with extreme fatigue. He also underwent rapid bodily deterioration. He had been tall, well-built, vigorous; he was now shrunken, frail, a shadow of the vital man he had once been.

On his eightieth birthday a deputation of prominent physicians that had come to extend the good wishes of many scientific bodies was asked to limit its visit to fifteen minutes. A longer visit, Lister feared, would be too strenuous for him. And when in the following year, 1908, he went to the Guildhall to receive the Freedom of the City of London, people who had not seen him for several years hardly recognized him. His few words, expressing gratitude for the honor that had been conferred upon him, were hardly audible to most of the audience. He never again appeared in public.

Lister also requested that his nephews and nieces, of whom he was very fond, should visit him less often. It was too much of a strain for him and also too painful, for when they did come he would look at them wistfully, and tell them that he had “so much to say,” without being able to do so.

Accompanied by his sister-in-law, Miss Syme, who had come to live with him after Agnes’s death, and his old butler, Jones, he went to Walmer, a sleepy old port on the English Channel. His house was separated from the sea by a narrow lawn, and on fine mornings he would sit in his armchair looking out upon the waters of which he was so fond. His hearing and his eyesight failed, and he was no longer able to read or write. He could also hardly dictate letters, as he had often done during these last years. Most of the time he now spent in bed. He died in his sleep on the morning of February 10, 1912, just two months short of his eighty-fifth birthday.

He had always hoped that he would one day be able to return to London. He had ordered that his horses be kept ready for the journey, and for four years they had been standing in their stables in London, waiting to bring their master back home. They were still awaiting his call on the morning of February 10 th.

On the news of Lister’s death the Lancet published an obituary in which it called him the “greatest modern Englishman,” “the world’s greatest surgeon.” These effusive tributes from the publication which had opposed him so vigorously during his years of struggle would probably have been greeted by Lister with a wry smile. He might have been reminded of what he had said five years earlier upon receiving the birthday congratulations of the Council of the Royal College of Surgeons: “I could not have believed that that body could so express itself.”

In the early afternoon of February 16th a public funeral service was held for him in Westminster Abbey. Burial of his body in the Abbey, one of the greatest honors England has to bestow, was offered, but it was gratefully declined by his executors in deference to his often-expressed wish to be buried beside his wife. The service was attended by representatives of the King and Queen, by the Prime Minister and other high government officials, by many of the ambassadors accredited to the Court of St. James’s, by representatives from the Royal Society and the Royal Colleges of Surgeons of London and Edinburgh and from innumerable universities and scientific bodies.

After the ceremony his coffin was taken to the West Hampstead Cemetery and placed in a grave next to the one in which he had buried Agnes almost twenty years before. A firm believer in the immortality of the soul, Lister had been upheld during all these long, sad years by the conviction that he would be reunited with her in the hereafter.

EPILOGUE

Mankind owes everlasting gratitude to Joseph Lister. His discovery of the cause of wound infection and his introduction of the antiseptic treatment revolutionized surgery. Antisepsis transformed surgery from a gamble with fate to a procedure that could be undertaken with confidence. It made not only the surgery of Lister’s day immeasurably safer; it made possible operations no surgeon in the past would have dared to perform. The joints, the abdominal cavity, the chest, eventually even the brain, became accessible to the surgeon’s knife.

Joseph Lister inaugurated a new era in surgery. He was, indeed, in the words of the Lancet, the “Master Surgeon.”

CHRONOLOGY OF IMPORTANT EVENTS IN THE LIFE OF JOSEPH LISTER

1827    Birth, April 5

1847    B.A. degree from University College, London

1852  M.B. degree from University College, London Admitted to Royal College of Surgeons of England. First published research (on muscular tissue of the iris)

1854    Appointed house surgeon, Royal Infirmary, Edinburgh

1855    First research on inflammation. Appointed extramural lecturer, Royal Infirmary, Edinburgh

1856   Marriage to Agnes Syme. Appointed Assistant Surgeon to the Royal Infirmary, Edinburgh. First research on coagulation of the blood

1860    Appointed Professor of Surgery, University of Glasgow

1861    Appointed Surgeon to the Royal Infirmary, Glasgow

1866    Antiseptic treatment first used in treating patients

1867    First publication on antiseptic treatment Antiseptic method first used in an operation

1869   Appointed Professor of Clinical Surgery, Edinburgh University

1871    Address in Surgery to British Medical Association in Plymouth

1876    Trip to America; address to International Medical Congress, Philadelphia

1877    Appointed Professor of Clinical Surgery, King’s College, London

1879    Address to International Medical Congress, Amsterdam

1880    Honorary degrees from Oxford and Cambridge Universities

1883    Made a baronet by Queen Victoria

1892    Participated in Pasteur’s seventieth birthday celebration, Paris

1895    Elected President of the Royal Society of London

1896    Elected President of the British Association for the Advancement of Science

1897    Elevated to the peerage

1898    Given the Freedom of the City of Edinburgh 1908 Given the Freedom of the City of London 

1912     Death, February 10

SOURCES

cheyne, william watson, Lister and His Achievement. London, Longmans, Green & Company, 1925.

clarkson, thomas, Quaker Portraiture, 3rd ed. London, Longman, Hurst, Rees and Orme, 1807.

erichsen, john eric, On Hospitalism and the Causes of Death after Operations. London, Longmans and Company, 1874.

godlee, rickman John, Lord Lister, 3rd ed. Oxford, The Clarendon Press, 1924.

hunter, william, Historical Account of Charing Cross Hospital and Medical School. London, J. Murray, 1914.

Joseph, baron lister, Collected Papers. Oxford, The Clarendon Press, 1909.

leeson, john rudd, Lister as I Knew Him. London, Bailliere, Tindal and Company, 1927.

pasteur, louis, Oeuvres de Pasteur, Vol. 2. Paris, Masson & Cie., 1922.

stewart, john, “First Listerian Oration.” Canadian Medical Association Journal, Special Number (October, 1924).

Thomson, st. clair, “The Coming of Lister to London.” St. Bartholomew's Hospital Journal, Vol. 28, No. 4 (1921).

——, “Lister, 1827-1927: A House Surgeon’s Memories.” King's College Hospital Gazette, Vol. 16, No. 4 (1937).

——, “Lister at University College and Hospital.” University College Hospital Magazine, Vol. 24 (1939), pp. 5-15.

turner, a. logan, ed., Joseph, Baron Lister, Centenary Volume, 1827-1927. Edinburgh and London, Oliver & Boyd, 1927.

INDEX

The index below contains all the original topics and subtopics from the print version of Master Surgeon—A Biography of Joseph Lister.

Ackworth School

Addresses, Lister’s: British Association for the Advancement of Science, British Medical Association, Edinburgh, Introductory Lecture, Edinburgh, Medical School graduation, Edinburgh, testimonial dinner, Glasgow University, Huxley Lecture, International Medical Congress, Amsterdam, International Medical Congress, Philadelphia,  King’s College Medical School, Pasteur’s seventieth birthday celebration, Paris, Royal Society of London, See also Papers, Publications.

America, Lister’s journey to

Amputation. See also Publications.

Anderson, Dr. Thomas

Anesthesia: ether, introduction of, surgical progress because of, See also Publications.

Animals, experiments on, Lister’s views

Antiseptic principle. See also Antiseptic treatment. Antiseptic surgery. See Antiseptic treatment Surgery

Antiseptic treatment: addresses on, Lister’s,  carbolic acid used in, (see also Carbolic acid) English reception of, European reception of, experiments with, Lister’s, fracture, use in treatment of, germ theory, basis in,  (see also Putrefaction, germ theory of) introduction of, principle of, objective of,  publications on, Lister’s (see Publications) students’ reception of, surgery, effect on, surgery, first used in, surgical use of, debate on,  theoretical basis of, ,  wound infection, effect on

Bacteriology

Baronetcy, Lister’s  

Birth, Lister’s,

Blood, coagulation of. See Coagulation.

Blood poisoning (pyemia) . See also Wound infection.

Boarding school, Lister in, 

British Association for the Advancement of Science,  

British Medical Association. See also Addresses.

British Medical Journal, quoted,  

Brown, Dr. John  

Burial, Lister’s,  

Buxton, Lister at,

Cambridge University 

Carbolic acid, Carlisle, Scotland, used in, discovery of, sewage, use on, spray, use as,  surgical dressings, antiseptic for, wounds, effect on,  

Carlisle, Scotland  

Charing Cross Hospital Medical School

Cheyne, Sir William Watson

Children, Lister and, 

Chloroform narcosis  

Chronology of Lister’s life 

Coagulation of blood, Lister’s research on, 

Compound fracture. See Fracture.

Cooper, Sir Astley

Death, Lister’s. See also Lister, Agnes Lister, Joseph Jackson.

Degrees, Lister’s,  

Diseases. See Hospital diseases.

Edinburgh College of Surgeons. See also Royal College of Surgeons.

Edinburgh, Freedom of City given to Lister  

Edinburgh Medical School. See also Addresses. 

Edinburgh, Royal Infirmary. See Royal Infirmary, Edinburgh. 

Edinburgh, Royal Society of. See Royal Society of Edinburgh. 

Edinburgh students, letter from. See also Students. 

Engagement, Lister’s

Erichsen, Sir John  

Erysipelas. See also Wound infection.

Ether. See also Anesthesia. 

Events, important in Lister’s life

Experiments. See Animals, Antiseptic treatment, Coagulation of blood, Eye, Fermentation, Flask, Inflammation, Putrefaction, Spontaneous generation.

Eye, Lister’s research on  

Fermentation: Lister’s studies on, Pasteur’s studies on  

Flask experiment  

Fracture, compound: antiseptic treatment of,  distinguished from simple fracture, wound infection and

Fracture, simple. See also Fracture, compound.

Funeral, Lister’s 

Gangrene, 

Generation, spontaneous. See Spontaneous generation. 

Germs, disease, as cause of, See also Microbe Microorganism.

Germ theory. See Putrefaction, germ theory of.

Glasgow

Glasgow, Royal Infirmary. See Royal Infirmary, Glasgow.

Glasgow University, Lister appointed to. See also Addresses.

Godlee, Sir Rickman. See also Author’s Note in front of book.

Gower Street 

Harris, Isabella. See Lister, Isabella.

Holmes, Dr. Timothy

Hospital conditions

Hospital diseases. See also Blood poisoning, Erysipelas, Gangrene, Hospitalism, Wound infection.

Hospitalism. See also Hospital diseases.

Huxley Lecture. See also Addresses.

Huxley, Thomas

Immortality, Lister’s belief in

Infection. See also Wound infection.

Inflammation, Jones’s paper on, Lister’s studies on,

International Medical Congress: at Amsterdam, at Philadelphia, See also Addresses. Papers.

Iris of eye, Lister’s research on.

Italy, Lister’s comments on. See also Rapallo.

Jones, Professor Wharton 

King’s College, London, Hospital, Lister appointed Professor of Clinical Surgery,  Lister’s first lecture,  Lister’s retirement from,

Lancet, the, references to

Lectures, Lister’s. See Addresses. 

Letters, Lister’s, quoted: to his father, to the Lancet, to Queen Victoria, to his sister, to unidentified recipients, See also Lister, Agnes Lister, Joseph Jackson

Lister, Agnes death, description of, (illus.) engagement, letters, quoted, marriage  

Lister, Isabella  

Lister, John

Lister, Joseph Jackson (Lister’s father), death, letters from Lister (See Letters) letters to Lister, quoted, marriage, obituary notice of,  

Listerians  

Listerine

Liston, Dr. Robert

London, Freedom of City given to Lister

London, University College. See University College.

Mackenzie, Dr. Richard, 

Marriage, Lister’s,  

Medical standards, Lister on

Medicine, in Lister’s day, role of pure science in

Microbe (s). See also Germs, Microorganism.

Microorganism (s). See also Germs Microbe.

Millbank House

Morton, Dr. James 

Nussbaum, Professor von

Obituary, Lister’s. See also Lister, Joseph Jackson.

Operations. See also Surgery.

Operations, Lister’s. See also Surgeon, Lister as a.

Operating theatre, at Edinburgh

Oxford University

Paget, Sir James,

Papers, Lister’s: at Edinburgh College of Surgeons, at International Medical Congress, Philadelphia, at Royal Society of Edinburgh, See also Addresses Publications.

Pasteur, Louis, burial, fermentation, studies on, germs, discovery of in air, germs and putrefaction, studies on, seventieth birthday celebration, spontaneous generation, studies on 

Pasteurization

Patients, Lister and his

Peerage, Lister’s elevation to

Photographs of Lister, frontispiece

Physical description of Lister

Ponsonby, Sir Henry

Publications, Lister’s: on amputation, on anesthesia, on antiseptic treatment, on muscular tissue of iris, See also Addresses, Papers.

Pure science, role of in medicine

Putrefaction, germ theory of: antiseptic treatment based on, attacks on, Lister’s addresses on, Lister’s later views on,  Lister’s studies on,  Pasteur’s studies on, Schwann’s studies on, students’ reception of

Pyemia. See Blood poisoning.

Quaker (ism),

Rapallo (Italy), the Listers in. See also Italy.

Research. See Experiments.

Reti, Count

Retirement, Lister’s

Rokitanski, Professor

Royal College of Surgeons of England, Lister admitted to, See also Edinburgh College of Surgeons.

Royal Infirmary, Edinburgh, (illus.)

Lister appointed Assistant Surgeon to, Lister appointed extramural lecturer, Lister appointed house surgeon,  Lister appointed Professor of Clinical Surgery, See also Edinburgh Medical School Royal Infirmary, Glasgow.

Royal Infirmary, Glasgow

Lister appointed Surgeon to, See also Royal Infirmary, Edinburgh.

Royal Society of Edinburgh

Royal Society of London, Lister elected President of, See also Addresses.

St. John, Sisters of,  St. Thomas’s Hospital, debate at

Savory, Sir William

Saxtorph, Professor  

Schultze, Dr.  

Schwann, Dr.  

Sharpey, Dr. William  

Simple fracture, See Fracture. 

Simpson, Sir James 

Society of Friends, See Quakers. 

Speeches, Lister’s, See Addresses. 

Spontaneous generation,  defined, Pasteur’s studies on, Reti’s studies on  

Stewart, Dr. John  

Students, Lister’s. See Edinburgh students, Teacher Testimonials.

Studies. See Experiments. 

Surgeon, Lister as a, See also Operations, Lister’s.

Surgeoncies, Lister’s 

Surgery: anesthesia first used in, anesthesia, improvements in because of, antiseptic treatment in, in Lister’s day, revolutionized

Surgical dressings See Carbolic acid.

Syme, Agnes, See Lister, Agnes. 

Syme, Dr. James

Teacher, Lister as a,

Testimonials from students, . See also Edinburgh students.

Thiersch, Professor, 

Thomson, Dr. Allen,  

Treatment, antiseptic. See Antiseptic treatment.

University College, London, anesthesia first used at, founding of, Lister’s appointments to, Lister’s degrees from, Lister’s schedules at,  

Upton (Essex) 

Upton House, (illus.)

Victoria, Queen, baronetcy, confers on Lister,  letter from Lister,  letter to Lister, operation on, Lister’s, vivisection, views on,

Vivisection, See also Animals.

Volkmann, Professor von

Walmer, Lister at 

Warren, Dr. John Collins 

Wedding journey, Listers’ 

Wood, Dr. John

Wound infection, See also Antiseptic treatment, Blood poisoning, Erysipelas, Gangrene, Hospital diseases, Hospitalism