Joseph Lister
Joseph Lister, 1st Baron Lister, OM, PC, FRS, FRCSE, FRCPGlas, FRCS (5 April 1827 – 10 February 1912[1]) was a British surgeon, medical scientist, experimental pathologist and a pioneer of antiseptic surgery[2] and preventive healthcare.[1] Joseph Lister revolutionised the craft of surgery in the same manner that John Hunter revolutionised the science of surgery.[3]
"Lord Lister" redirects here. For other people, see Joseph Lister (disambiguation) and Lord Lister (disambiguation).
The Lord Lister
5 April 1827
Upton House, West Ham, England
10 February 1912 (aged 84)
Walmer, Kent, England
Hampstead Cemetery, London
- Joseph Jackson Lister (1786–1869)
- Isabella Harris
Surgical sterile techniques
- Royal Medal (1880)
- Cameron Prize for Therapeutics of the University of Edinburgh (1890)
- Albert Medal (1894)
- Copley Medal (1902)
From a technical viewpoint, Lister was not an exceptional surgeon,[2] but his research into bacteriology and infection in wounds raised his operative technique to a new plane where his observations, deductions and practices revolutionised surgery throughout the world.[4]
Lister's contributions were four-fold. Firstly, as a surgeon at the Glasgow Royal Infirmary, he introduced carbolic acid (modern-day phenol) as a steriliser for surgical instruments, patients' skins, sutures, surgeons' hands, and wards, promoting the principle of antiseptics. Secondly, he researched the role of inflammation and tissue perfusion in the healing of wounds. Thirdly, he advanced diagnostic science by analyzing specimens using microscopes. Fourthly, he devised strategies to increase the chances of survival after surgery. His most important contribution, however, was recognising that putrefaction in wounds is caused by germs, in connection to Louis Pasteur's then-novel germ theory of fermentation.[a][6]
Lister's work led to a reduction in post-operative infections and made surgery safer for patients, leading to him being distinguished as the "father of modern surgery".[7]
Education[edit]
School[edit]
As a child, Lister had a stammer and this was possibly the reason why he was educated at home until he was eleven.[35] Lister then attended Isaac Brown and Benjamin Abbott's Academy, a private[36] Quaker school in Hitchin in Hertfordshire.[37] When Lister was thirteen,[35] he attended Grove House School in Tottenham, also a private Quaker School[37] to study mathematics, natural science, and languages. His father was insistent that Lister received a good grounding in French and German, in the knowledge he would learn Latin at school.[38] From an early age, Lister was strongly encouraged by his father[8] and would talk about his father's great influence later in life, particularly in encouraging him in his study of natural history.[35] Lister's interest in natural history led him to study bones and to collect and dissect small animals and fish that were examined using his father's microscope[19] and then drawn using the camera lucida technique that his father had explained to him,[30] or sketched.[37] His father's interests in microscopical research developed in Lister the determination to become a surgeon[19] and prepared him for a life of scientific research.[8] None of Lister's relatives were in the medical profession. According to Godlee, the decision to become a physician seemed to be an entirely spontaneous decision.[39]
In 1843 his father decided to send him to university. As Lister was unable to attend either University of Oxford or the University of Cambridge owing to the religious tests that effectively barred him,[8] he decided to apply to the non-sectarian University College London Medical School (UCL), one of only a few institutions in Great Britain that accepted Quakers at that time.[40] Lister took the public examination in the junior class of botany, a required course that would enable him to matriculate.[41] Lister left school in the spring of 1844 when he was seventeen.[37]
Surgical profession 1854[edit]
Before Lister's studies of surgery, many people believed that chemical damage from exposure to "bad air", or miasma, was responsible for infections in wounds.[93] Hospital wards were occasionally aired out at midday as a precaution against the spread of infection via miasma, but facilities for washing hands or a patient's wounds were not available. A surgeon was not required to wash his hands before seeing a patient; in the absence of any theory of bacterial infection, such practices were not considered necessary. Despite the work of Ignaz Semmelweis and Oliver Wendell Holmes Sr., hospitals practised surgery under unsanitary conditions. Surgeons of the time referred to the "good old surgical stink" and took pride in the stains on their unwashed operating gowns as a display of their experience.[94]
Edinburgh 1853–1860[edit]
James Syme[edit]
Syme was a well-established clinical lecturer at Edinburgh University for more than two decades before he met Lister[95] and was considered the boldest and most original surgeon then living in Great Britain.[96] He became a surgical pioneer during his career, preferring simpler surgical procedures as he detested complexity,[95] in the era that immediately preceded the introduction of anaesthesia.[97]
In September 1823, at the age of 24, Syme made a name for himself by first performing an amputation at the hip-joint,[97][98] the first time in Scotland. Considered the bloodiest operation in surgery, Syme completed it in less than a minute,[95][97] as speed was essential in a time before anaesthesia. Syme became widely known and acclaimed for his development of a surgical operation that became known as Syme amputation, an amputation at the level of the ankle-joint, where the foot is removed and the heel pad is preserved.[99] Syme was considered a scientific surgeon, as evidenced by his paper On the Power of the Periosteum to form New Bone,[97] and became one of the first advocates of antiseptics.
Arrival in Edinburgh[edit]
In September 1853, Lister arrived in Edinburgh bearing letters of introduction from Sharpey to Syme.[100] Lister was anxious about his first appointment but decided to settle in Edinburgh after meeting Syme who embraced him with open arms, invited him to dinner and offered him an opportunity to assist in his private operations.[84]
Lister was invited to Syme's house, Millbank, in Morningside (now part of Astley Ainslie Hospital),[101] where he met, amongst others, Agnes Syme, Syme's daughter by another marriage and granddaughter of the physician Robert Willis.[102][103] While Lister thought that Agnes was not conventionally pretty, he admired her quickness of mind, her familiarity with medical practice, and her warmth.[103] Lister became a frequent visitor to Millbank and met a much wider group of eminent people than he would have in London.[104]
In the same month, Lister began work as an assistant to Syme at the University of Edinburgh[84] In a letter to his father, Lister was surprised at the size of the Infirmary and spoke about his impressions of Syme, "..is larger than I expected to find it; there are 200 Surgical beds, and a large number in other departments. At University College Hospital there were only about 60 Surgical beds, so altogether a prospect appears to be opening of a very profitable stay here. ...Syme is, I suppose, the first of British surgeons, and to observe the practice and hear the conversation of such a man is of the greatest possible advantage".[105] By October 1853, Lister decided to spend the winter in Edinburgh. Syme was so impressed by Lister, that after a month Lister became Syme's supernumerary house surgeon at the Royal Infirmary of Edinburgh[106] and his assistant in his private hospital at Minto House in Chambers Street.[101] As house surgeon, he assisted Syme during every operation, taking notes.[106] It was a much-coveted position[30] and gave Lister the option of choosing which of the ordinary cases he would attend.[19] During this period, Lister presented a paper at the Royal Edinburgh Medico-Chirurgical Society on the structure of cancellous exostoses that had been removed by Syme, demonstrating that the method of ossification of these growths was the same as that which occurs in epiphyseal cartilage.[107]
In September 1854, Lister's house surgeoncy appointment was finished.[108] With the prospect of being out of a job, he had spoken to his father about seeking a position at the Royal Free Hospital in London.[108] However, Sharpey had written to Syme, warning him that it was unlikely that Lister would be welcome at the Royal Free as he would have likely eclipsed Thomas H. Wakley, whose father held considerable sway at the hospital.[109] Lister then planned to tour Europe for a year.[110] However, an opportunity presented itself when the noted infirmary surgeon and surgical lecturer at the Edinburgh Extramural School of Medicine Richard James Mackenzie had died.[111] Mackenzie had been seen as a successor to Syme[111] but had contracted cholera in Balbec in Scutari, Istanbul, while on a four-month volunteer sabbatical as field surgeon to the 79th Highlanders during the Crimean War.[30] Lister took advantage of the situation and proposed to Syme that he take over Mackenzie's position to become assistant surgeon to Syme.[110] Syme initially rejected the idea as Lister was not licensed to operate in Scotland, but later warmed to the idea.[110] In October 1854, Lister was appointed a lecturer[112] Lister successfully transferred the lease held by Mackenzie at his lecture room at 4 High School Yards, to himself. On 21 April 1855, Lister was elected a Fellow of the Royal College of Surgeons of Edinburgh[113] and two days later, rented a house at 3 Rutland Square for living.[30] In June 1855, Lister made a hurried trip to Paris to take a course on operative surgery on the dead body and returned in June.[113]
Lister Memorial Fund[edit]
Following his death, the Lord Lister Memorial Fund was established by the Royal Society as a public subscription to raise monies for the public good in honour of Lord Lister.[406] It led to the founding of the Lister Medal, considered the most prestigious prize that can be awarded to a surgeon.
Lister Frieze, Polyclinic Umberto I hospital in Rome. The tympanum sculptures show Lister operating
