Joseph Lister

English physician

• Born: April 5, 1827
• Birthplace: Upton, Essex, England
• Died: February 10, 1912
• Place of death: Walmer, Kent, England

Combining skill as a laboratory scientist with great technical ability at surgery, Lister developed and helped to propagate antiseptic surgery, which fundamentally changed surgical procedures and saved uncounted lives.

Early Life

Joseph Lister was born in a town just east of London. His parents, Joseph Jackson and Isabella Lister, were Quakers, and the family—there were six children—was unusually close. Lister’s father owned a prosperous wine business and was a scientist in his own right. His development of the achromatic lens made a significant improvement in the microscope, and he became a Fellow of the Royal Society. Paternal example helped Lister develop an interest in and skill at scientific investigation.

After his primary education in Quaker schools, Lister entered University College, London, the only option for non-Anglicans interested in medicine. Unlike most mid-nineteenth century medical students, Lister first studied for an arts degree. Then, following a brief bout with nervous problems, he began the study of medicine, taking his degree in 1852. He won a number of prizes for scholarship, served as house physician and surgeon at University Hospital, and became a fellow of the Royal College of Surgeons of England. Lister’s decision to be a surgeon was an unlikely one, for with anesthesia being then only recently developed and the problems of infection still ill-understood, surgery was a brutal and little-respected specialty.

Two professors had significant influence on Lister. Wharton Jones, who did important work on blood circulation and inflammation, inspired an interest in the nature of inflammation that was important in the eventual understanding of infection. William Sharpey, one of the first modern physiologists, not only gave the young Lister a solid foundation in his field but also, when asked about the best way to get more experience, suggested visits to Edinburgh and the Continent. He also provided an introduction to James Syme, whose work at Edinburgh had made him the most distinguished surgeon in Great Britain and perhaps all of Europe.

Lister’s visit to Edinburgh, planned for a month, lasted seven years, a period during which he completed his apprenticeship and began his career in earnest. His relationship with Syme was quickly one of friendship and mutual respect. He accepted a position as Syme’s house surgeon, an unusually modest post for a man of his credentials. His willingness to serve as Syme’s assistant seems to have reflected Lister’s sincere desire to learn more, humility arising from his Quaker background, and perhaps some personal inclination. He not only found Syme extremely congenial but also married Syme’s daughter, Agnes, in 1856. The match proved excellent. Agnes Syme Lister was better educated than most Victorian women, and she discussed and even helped her husband with his scientific work. The two, though sorry that they never had children, were devoted to each other until her death during an 1893 European tour.

In 1856, a year after Lister was made lecturer on surgery at the Edinburgh School of Medicine, he was appointed assistant surgeon at the Royal Infirmary. Scottish medicine had for years been at the intellectual forefront of the field, and so for Lister maturing in that country was, if not socially a plus, an excellent opportunity.

The mature Lister was taller than average, well built, and strong. As he aged, he tended to stoutness and wore “muttonchop” whiskers, shaving his chin and around his mouth. Contemporaries reported that he always gave an impression of health and vigor. In manner he was reserved and proper. Although he was unusually thoughtful of and kind to patients, his students gave him the nickname “the Chief” and did not find him particularly approachable. His manner appears to have been a mixture of his Quaker heritage—although he left the Society of Friends when he married outside it—and a natural shyness. His personality, combined with a strict forthrightness, did not help win supporters for his antiseptic theory.

Life’s Work

Although identified with his later development of antiseptic surgery, Lister began serious scholarly work promptly after graduation—he published his first article in 1853—and continued research while working with Syme. In 1857, he made a presentation concerning inflammation to the Royal Society, though he had not yet begun to include infection as part of this work. Such experimentation was unusual for surgeons of the period.

In 1860, Lister, with eleven published research papers to his credit, was appointed surgeon at the Glasgow Royal Infirmary and elected a fellow of the Royal Society. His research expanded to the coagulation of blood, about which he gave a major address to the Royal Society in 1863. Over the next two years, the theory that was to dominate the rest of his life was developed. He became acquainted with the work of the French chemistLouis Pasteur concerning fermentation. This led to experiments testing whether putrefaction occurred in substances that air could not reach and the conclusion that hospital infections such as gangrene were caused by microbes in the air or on the hands and instruments of doctors and nurses. He decided that the cycle could be broken by the introduction of a proper antiseptic, and knowing that carbolic acid had been used to purify sewers at Carlisle, he decided to try a dilute mixture on the first appropriate case that came under his care.

Lister first used antiseptics on compound fractures. Such injuries were routinely treated by amputation because setting them almost inevitably resulted in blood poisoning and/or gangrene, and though the stump left after amputation almost always became infected, because the wound could drain, the patient sometimes survived. Using carbolic acid first directly in the wound and later increasingly as part of the dressing to exclude germs, Lister found that such fractures could be treated usually with no infection at all. Between March and July of 1867, Lancet carried in five installments the report of Lister’s initial antiseptic treatments. Because of Lister’s modest claims and the profession’s conservatism about innovation, antiseptic surgery was initially taken as a method for the specific treatment of compound fractures rather than a general principle.

Over the next twenty years, Lister struggled to refine the antiseptic procedure and persuade his skeptical and sometimes self-serving colleagues to adopt it. His work ranged from such physiological studies as the importance of blood clots in healing to investigation of ligatures to replace the previously used silk and linen, which had to be pulled out of the wound once ulceration loosened them, often causing secondary hemorrhaging. He found that catgut treated with carbolic acid to prevent the passage of infection into the wound was absorbed by the body. In 1869, Lister returned to Edinburgh to replace Syme, who was ill and going into retirement, as Regius Professor of Clinical Surgery at the University of Edinburgh and Surgeon to the Royal Infirmary.

During the early 1870’s, Lister began to use a spray made with carbolic acid to keep the air clean any time a wound was exposed and began to search for dressings that would be an effective barrier to infection. By the late 1880’s, he had settled on gauze impregnated with cyanide of mercury and zinc. Although the spray was unpleasant and soon lost favor—Lister dropped it himself in 1887—its use coincided with increasing reduction of the use of carbolic acid in the wound itself, presaging the development of aseptic surgical techniques in the twentieth century.

Lister’s wards were the healthiest in Edinburgh, as healthy as they had been in Glasgow, and he continued to expand his repertoire of operations. He was successfully applying surgical treatments to cases that would not have even been accepted into hospitals only a few years before. It is sad to note that his fame spread on the Continent—his wards were being visited by European surgeons by 1872—long before his British colleagues gave his techniques much more than scorn.

James Simpson, well known and respected for his introduction of anesthesia into the British Isles, had concluded that hospital infections could best be prevented by frequent replacement of facilities. He advocated quickly built wooden hospitals that could be abandoned when infections became rampant, and he acquired his considerable prestige not only in advancing his own ideas but also in deprecating those of Lister. Poorly conducted experiments with antiseptics, of course, failed, and the annoyed Lister resisted publication of much of his work lest it lead to more harm than good. Students and others who worked closely with Lister personally began slowly to spread the corrected antiseptic technique.

In 1877, Lister was invited to become Professor of Clinical Surgery at King’s College in London. He was reluctant to leave Edinburgh, where he had become popular—his students organized a petition begging him to remain—and his fame was secure, but he felt duty-bound to go because London was the professional center of the country. Success in London would mean that his antiseptic techniques would gain a wide audience in short order, and thus he accepted the position, also becoming Surgeon to King’s College Hospital.

Within a decade, Lister was a dominant figure in British medicine. Honors followed thick and fast. In 1883, he was created a baronet, and in 1897, he was raised to the peerage as Baron Lister. He retired from teaching in 1892 and private practice in 1896 but served as president of the Royal Society from 1895 to 1900. In 1896 and 1897, he helped reorganize the Jenner Institute of Preventive Medicine, which he had helped to found and that was later renamed the Lister Institute of Preventive Medicine. In 1902, Lister was selected as an original member of the Order of Merit, founded by King Edward VII, but in the following year he fell ill and was an invalid until his death on February 10, 1912.

Significance

In many ways, Joseph Lister typified the Victorian era. Driven by the Nonconformist ethic calling for hard work and service, he also had the British genius for technology. Choosing to be a surgeon at a time when surgeons’ most prized skill was speed at completing a procedure before the shock of the operation killed the unanesthetized patient and when infection killed many of those who survived surgery, he transformed the profession. Lister recognized the value of anesthesia and was among the first to slow his operations, preferring precision to speed. He then took advantage of scientific discoveries—his own but to a greater degree those of Pasteur—to develop antiseptic surgical techniques. The nineteenth century was a time when British manufacturers were preeminent in applying science to practice in the name of profit; Lister, in much the same way, applied it to the easing of human suffering.

Bibliography

Cartwright, Frederick Fox. Joseph Lister: The Man Who Made Surgery Safe. London: Weidenfeld & Nicolson, 1963. Well written but based largely on secondary sources.

Cheyne, Sir William W. Lister and His Achievement. London: Longmans, Green, 1925. Written by a house surgeon and admirer of Lister. Includes a summary of Lister’s life and a longer appendix appraising his work.

Dormandy, Thomas. Moments of Truth: Four Creators of Modern Medicine. Hoboken, N.J.: Wiley, 2003. Part 3 of this medical history book focuses on Lister and the development of antiseptic surgery.

Fisher, Richard B. Joseph Lister. New York: Stein & Day, 1977. A scholarly, well-researched biography, though a bit dry in style.

Gaw, Jerry L.“A Time to Heal”: The Diffusion of Listerism in Victorian Britain. Philadelphia: American Philosophical Society, 1999. Examines several factors that helped spread Lister’s antiseptic surgery techniques in mid-nineteenth century Britain. Those factors include medical administration, social interpretation, national competition, and experimental investigation. Aimed at readers with some technical knowledge of medicine.

Godlee, Sir Rickman John. Lord Lister. Oxford, England: Clarendon Press, 1924. A typical late-Victorian biography written by Lister’s nephew. Includes much of Lister’s correspondence.

Leeson, John R. Lister as I Knew Him. London: Balliere, Tindall and Cox, 1927. Reminiscences by a student and assistant of Lister. The style is chatty and personal, but the author did not know Lister intimately.

Turner, A. Logan, ed. Joseph, Baron Lister: Centenary Volume, 1827-1927. London: Oliver and Boyd, 1927. A collection of essays, including a biographical sketch, mostly by contemporaries, colleagues, and friends of Lister.

Waller, John. Einstein’s Luck: The Truth Behind Some of the Greatest Discoveries. New York: Oxford University Press, 2002. An iconoclastic view of science. In Chapter 8, “Was Joseph Lister Mr. Clean?,” Waller argues that Lister’s antiseptic hospital wards were actually quite dirty.

Woodward, John. To Do the Sick No Harm: A Study of the British Voluntary Hospital System in 1875. Boston: Routledge & Kegan Paul, 1974. A useful and scholarly study. Excellent background for the study of Lister’s work.