Joseph Lister

It is difficult in a short biography to convey the magnitude of Joseph Lister’s contribution to medicine and to mankind. He could justly be regarded as the surgeon who did more to improve surgical standards than any other. His introduction of antisepsis in surgery improved results to such an extent that surgery became measurably safer and thus more widely applicable. He achieved more honours than any other British surgeon – the first doctor in Britain to be made a Baron; a founder member of the Order of Merit; a Fellow by examination of this College and an Honorary Fellow. Yet contemporaries describe him as a gentle and kindly man, quiet, modest with a disarming smile and concern for the welfare of others.

Joseph Lister was born in Upton House in what today is Westham Park in London. His father, Joseph Jackson Lister, had been brought up a Quaker and was devout in that faith. He had achieved fame in his own right. Although a Wine Shipper by trade he had a gift for mathematics and applied this to the curvature of the lenses required for microscopes and began to grind these himself. The resultant improvements to the achromatic microscope lens resulted in him being elected a Fellow of the Royal Society. His son Joseph was educated at Quaker schools, firstly at Hitchen and then at Grove House in Tottenham before enrolling in University College, London. He had decided early in life to become a surgeon but graduated firstly in art in 1847. His interest in surgery during this time must surely have been inspired by being present at the first public demonstration of an ether anaesthetic in England by Robert Liston. Liston, an Edinburgh surgeon renowned for his operative speed and dexterity had become Professor of Surgery at University College Hospital. At the time there was increasing interest in hypnosis or mesmerism to facilitate surgical procedures. After the operation, an amputation, Liston famously remarked to the audience “This Yankee dodge gentleman beats mesmerism hollow”. Lister was to recall his excitement when he described the occasion to the British Association 50 years later.

For about a year whilst an undergraduate Lister underwent a period of serious self doubt about his career. He lost motivation and became depressed. His health recovered and he resumed his studies with vigour finding particular inspiration from the Professor of Physiology, William Sharply (cross reference) a Scot who had left Edinburgh to become the first Professor of Physiology at University College. After appointments as House Surgeon and House Physician he took to dissection of animals and conducted research using the microscope, the value of which had been taught him at an early age by his father. Encouraged by Sharply he continued to dissect and sketch animals. He was elected Fellow of The Royal College of Surgeons of England in 1852.

Professor Sharply advised that he should tour continental centres for further studies starting with Edinburgh and wrote a letter of introduction to James Syme. Syme at this stage was widely regarded as the leading surgeon in Britain and Joseph Bell (cross reference) who had been one of his assistants called him “the originator of nearly every improvement in surgery in the century”. Intending to stay in Edinburgh for a month, he stayed for seven years. Syme was so impressed with the young Quaker that he appointed him House Surgeon in The Royal Infirmary and assistant at his private hospital in Minto House. He also became a frequent visitor to Syme’s house in Millbank in the Grange area – now part of the Astley Ainslie Hospital. This resulted in his meeting, and marrying Agnes, Syme’s eldest daughter. As a result he resigned his membership of the Society of Friends and became a Scottish Episcopalian but retained many of his Quaker characteristics to the end. Throughout his life for example he would refer to family as “thee and thou” when writing and speaking. His Edinburgh career flourished with a successful lecture course which he established in a lecture theatre in High School Yards and researches on the pathology of inflammation and coagulation of blood.

In 1860 he was appointed Regius Professor of Clinical Surgery in the University of Glasgow. He was appointed surgeon to the Glasgow Royal Infirmary, the newest of the six Scottish Royal Infirmaries which was of a similar size to St. Bartholomew’s the largest hospital in London. After three years he applied for the Regius Chair of Surgery in Edinburgh but ,surprisingly, was unsuccessful, the appointment going to James Spence (qv).

Disappointed he threw himself anew into research on suppuration. Sepsis, a term which he himself coined, seems to have been particularly common in Glasgow Royal Infirmary. The correlation between sepsis and dirt in hospitals had been established shortly before and the need for doctors to wash their hands had been established in the 1840s by Oliver Wendle Holmes in Boston and by Ignaz Semmelweis in Vienna. In 1865 Thomas Anderson, the Professor of Chemistry told him about Pasteur’s work on putrefaction and specifically the findings that the process of fermentation was caused by “small corpuscles” and that putrefaction could be prevented by excluding air from the tissues concerned. Lister introduced chemical antisepsis introducing carbolic acid into wounds famously using it in the compound tibial fracture of James Greenleas. In 1867 he published the epoch making papers “On a new method of treating compound fracture and abscess etc. with observations on the conditions of suppuration”. He went on to develop the carbolic spray which was used to spray the atmosphere around the wound during operations and during dressings.

Lister made a second major contribution to surgical practice – the absorbable ligature. As a result of his work on germ theory, Lister appreciated that the silk sutures customarily left protruding from wounds provided a track through which bacteria could produce infection around the suture. Catgut was readily available as it was used for the stringing of musical instruments such as violins and guitars. Lister devised a catgut ligature which was treated with carbolic and the problem of deep sepsis was dramatically reduced. To overcome the problem of rapid absorption of the catgut he soaked it in chromic acid and introduced chromic catgut into surgical practice through his publication of the technique in 1881.

In 1869 he had followed Syme as Regius Professor of Clinical Surgery in Edinburgh. Here he consolidated his publications and was forced to defend it against powerful enemies who included James Y. Simpson. Increasingly, however, his technique found favour throughout Europe and the World. He became Surgeon to the Queen in Scotland using the antiseptic technique on Queen Victoria when he drained an abscess at Balmoral. The successful outcome may also have been aided by the use of a rubber drainage tube, the first recorded use of this in the country.

From his home in 9 Charlotte Square, one of the most prestigious addresses in Edinburgh, he established a large and successful surgical practice.

Following the death of Sir William Ferguson(qv), Professor of Clinical Surgery in Kings College, London , Lister was appointed to that post taking with him as House Surgeon W. Watson (later Sir Watson) Cheyne. Lectures and publications on improvements in antiseptic practice followed. He now enjoyed a world wide reputation and corresponded with Pasteur whose discovery of the germ theory of putrefaction he always freely acknowledged. Yet his return to London was not triumphant. Students demonstrated their boredom with his lectures and stayed away; the nurses opposed the introduction of his antiseptic techniques, and the establishment resented his criticism of London teaching methods. With time all of these were won over. He was elected to the Council of The Royal College of Surgeons of England and became its Vice President. In 1897 he was elected Baron Lister of Lyme Regis and was elected President of The Royal Society, the first surgeon to hold that office. He became Serjeant Surgeon to Queen Victoria and on the coronation of King Edward VII was chosen as one of the 12 original members of the Order of Merit. Having served on the Council of The Royal College of Surgeons of Edinburgh he became its only Fellow by examination to receive the Honorary Fellowship. Honours from Institutions and Universities around the World followed. He became a Freeman of the City of London in 1907 and of Edinburgh in 1908. Joseph Baron Lister died peacefully in 1912 at the age of 85. With no children the Barony died with him. His contributions to surgery must rank among the greatest ever made.