and made camera lucida sketches of the appearances revealed
by the microscope.
To realize Lister’s work it is necessary to remember the condition of surgical practice at that date. About the middle of the 19th century the introduction of anaesthetics had relieved the patient of much of the horror of the knife, and the surgeon of the duty of speed in his work. The agony of the sufferer had naturally and rightly compelled the public to demand rapid if not slap-dash surgery, and the surgeon to pride himself on it. Within decent limits of precision, the quickest craftsman was the best. With anaesthetics this state of things at any rate was changed. The pain of the operation itself no longer counted, and the surgeon was enabled not only to be as cautious and sedulous as dexterous, but also to venture upon long, profound and intricate operations which before had been out of the question. Yet unhappily this new enfranchisement seemed to be but an ironical liberty of Nature, who with the other hand took away what she had given. Direct healing of surgical wounds (“by first intention”), far from being the rule, was a piece of luck too rare to enter into the calculations of the operator; while of the graver surgical undertakings, however successful mechanically, the mortality by sepsis was ghastly. Suppuration, phagedaena and septic poisonings of the system carried away even the most promising patients and followed even trifling operations. Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, dreaded the very name of hospital, and the most skilful surgeons distrusted their own craft. New hospitals or new wards were built, yet after a very short time the new became as pestiferous as the old; and even scrupulous care in ventilation and housemaids’ cleanliness failed to prevent the devastation. Surgery had enlarged its freedom, but only to find the weight of its new responsibilities more than it could bear.
When Lister was appointed to the chair of surgery in Glasgow the infirmary of that city was a hotbed of septic disease; so much so that his hospital visits evidently distressed him greatly. Windows were widely opened, piles of clean towels were supplied, but still the pestilence stalked through the wards. The building stands to-day as it stood then, with no substantial alteration; but by the genius of Lister its surgical wards are now as free from septic accidents as the most modern hospital in the land. James Simpson, early in the ’sixties, pathetically denounced the awful mortality of operations in hospitals, and indeed uttered desperate protests against the hospital system itself; yet, not long afterwards, Lister came to prove that it was not in the hospital that the causes of that mortality lay hidden, but in the operator himself, his tools and his assistants. Happily this beneficent discovery was made in time to preserve the inestimable boon of the hospital system from the counsels of despair. When Lister took up the task speculation was on the wrong tack; the oxygen of the air was then supposed to be the chief cause of the dissolution of the tissues, and to prevent access of air was impossible. For instance, a simple fracture, as of a bone of the leg, would do perfectly well, while in the very next bed a compound fracture—one, that is, where the skin is lacerated, and access to the seat of injury opened out—would go disastrously wrong. If the limb were amputated, a large proportion of such cases of amputation succumbed to septic poisoning.
On graduation as bachelor of medicine, Lister went to Edinburgh, where he soon afterwards became house-surgeon to Mr Syme; and he was much impressed by the skill and judgment of this great surgeon, and also by the superiority of his method of dressing recent wounds with dry lint, as compared with the “water dressing” in use at University College. Yet under these more favourable conditions the amelioration was only one of degree; in most wounds indeed “union by first intention” was rendered impossible by the presence of the silk ligatures employed for arresting bleeding, for these could come away only by a process of suppuration. On the expiry of his house-surgeoncy in Edinburgh, Lister started in that city an extra-academical course of lectures on surgery; and in preparation for these he entered on a series of investigations into inflammation and allied subjects. These researches, which were detailed fully in three papers in Phil. Trans. (1859), and in his Croonian lecture to the Royal Society in 1863, testified to an earnestness of purpose, a persevering accuracy of observation and experiment and an insight of scientific conception which show that if Lister had never developed the aseptic method of surgery, he would have taken a very high place in pathology. In his speech in Paris at the Thirteenth International Congress of Medicine in 1900, Lord Lister said that he had done no more than seize upon Pasteur’s discoveries and apply them to surgery. But though Lister saw the vast importance of the discoveries of Pasteur, he saw it because he was watching on the heights; and he was watching there alone. From Pasteur Lister derived no doubt two fruitful ideas: first, that decomposition in organic substances is due to living “germs”; and, secondly, that these lowly and minute forms of vegetable life spring always, like higher organisms, from parents like themselves, and cannot arise de novo in the animal body. After his appointment to the Glasgow chair in 1860, Lister had continued his researches on inflammation; and he had long been led to suspect that decomposition of the blood in the wound was the main cause of suppuration. The two great theories established by Pasteur seemed to Lister to open out the possibility of what had before appeared hopeless—namely, the prevention of putrefaction in the wound, and consequently the forestalling of suppuration. To exclude the oxygen of the air from wounds was impossible, but it might be practicable to protect them from microbes.
The first attempt to realize this idea was made upon compound fractures; and the means first employed was carbolic acid, the remarkable efficacy of which in deodorizing sewage made Lister regard it as a very powerful germicide. It was applied to the wound undiluted, so as to form with the blood a dense crust, the surface of which was painted daily with the acid till all danger had passed. The results, after a first failure, were in the highest degree satisfactory, so that, as Lister said in his presidential address to the British Association in Liverpool, he “had the joy of seeing these formidable injuries follow the same safe and tranquil course as simple fractures.” The caustic property of undiluted carbolic acid, though insignificant in comparison with the far greater evils to be avoided in compound fracture, made it unsuited for general surgery. To make it applicable to the treatment of abscesses and incised wounds, it was necessary to mitigate its action by blending it with some inert body; and the endeavour to find the best medium for this purpose, such as to combine perfect antiseptic efficiency with the least possible irritation of the tissues, formed the subject of experiments continued for many years in the laboratory and in the ward. At one stage in these inquiries an attempt was made to provide an atmosphere free from living organisms by means of a fine spray of a watery solution of carbolic acid; for it was then supposed by Lister to be necessary not only to purify the surgeon’s hands and instruments and the skin of the patient about the seat of operation, but also to wage war with the microbes which, as Pasteur had shown, people every cubic inch of the air of an inhabited room. Under the use of the spray better results were obtained than ever before, and this success encouraged its use. But researches carried on for several years into the relations of the blood to micro-organisms led Lister to doubt the harmfulness of the atmospheric dust. At the London Congress in 1881 he narrated experiments which proved that the serum of the blood is a very unfavourable soil for the development of the bacteria diffused through the air, and others which showed that the cells of an organizing blood-clot have a very remarkable power of disposing of microbes and of limiting their advance. Hence he considered it probable that in surgical operations the atmosphere might be disregarded altogether.[1] As long, however, as this was only a matter of probability, he did not dare to discard the spray. But at length, at the Berlin Congress in 1890, he was able to announce that the certainty he had so long desired had been arrived at. A careful consideration of the physical
- ↑ See Trans. of the International Medical Congress (1881), vol. ii. p. 373.
