Joseph Lister, 1st Baron Lister (5 April 1827 – 10 February 1912) was an English surgeon, medical scientist, experimental pathologist and pioneer of antiseptic surgery and preventive healthcare. Lister revolutionised the craft of surgery by the use of close anatomical observation, in the same manner that John Hunter revolutionised the science of surgery.
From a technical viewpoint, Lister was not an exceptional surgeon, but his research into bacteriology and infection in wounds revolutionised surgery throughout the world.
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 analysing 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.
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".
Early life
Lister was born to a prosperous, educated Quaker family in the village of Upton, then near but now in London, England. He was the fourth child and second son of four sons and three daughters born to gentleman scientist and wine merchant Joseph Jackson Lister and school assistant Isabella Lister née Harris. The couple married in a ceremony held in Ackworth, West Yorkshire on 14 July 1818.
Lister's paternal great-great-grandfather, Thomas Lister was the last of several generations of farmers who lived in Bingley in West Yorkshire. Lister joined the Society of Friends as a young man and passed his beliefs on to his son, Joseph Lister. He moved to London in 1720 to open a tobacconist's shop in Aldersgate Street in the City of London. His son, John Lister, was born there. Lister's grandfather was apprenticed to watchmaker Isaac Rogers, in 1752 and followed that trade on his own account in Bell Alley, Lombard Street from 1759 to 1766. He then took over his father's tobacco business, but gave it up in 1769 in favour of working at his father-in-law Stephen Jackson's business as a wine-merchant at No 28 Old Wine and Brandy Values on Lothbury Street, opposite Tokenhouse Yard.
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His father was a pioneer in the design of achromatic object lenses for use in compound microscopes He spent 30 years perfecting the microscope, and in the process, discovered the Law of Aplanatic Foci, building a microscope where the image point of one lens coincided with the focal point of another. Up until that time, the best higher magnification lenses produced an excessive secondary aberration known as a coma, which interfered with normal use. It was considered a major advance that elevated histology into an independent science. By 1832, Lister's work had built a reputation sufficient to enable his being elected to the Royal Society. His mother, Isabella, was the youngest daughter of master mariner Anthony Harris. Isabella worked at the Ackworth School, a Quaker school for the poor, assisting her widowed mother, the superintendent of the school.
The eldest daughter of the couple was Mary Lister. On 21 August 1851, she married the barrister Rickman Godlee of Lincoln's Inn and the Middle Temple, who belonged to the Friends meeting house in Plaistow. The couple had six children. Their second child was Rickman Godlee, a neurosurgeon who became Professor of Clinical Surgery at the University College Hospital and surgeon to Queen Victoria. He became Lister's biographer in 1917. The eldest son of Joseph and Isabella Lister was John Lister, who died of a painful brain tumour. With John's death, Joseph became the heir of the family. The couple's second daughter was Isabella Sophia Lister, who married Irish Quaker Thomas Pim in 1848. Lister's other brother William Henry Lister died after a long illness. The youngest son was Arthur Lister, a wine merchant, botanist and lifelong Quaker, who studied Mycetozoa. He worked alongside his daughter Gulielma Lister to produce the standard monograph on Mycetozoa. By 1898, Lister's work had built a reputation sufficient to enable his election to the Royal Society. Gulielma Lister, a talented artist, later updated the standard monograph with colour drawings. Her work built a reputation sufficient to be elected a fellow of the Linnean Society in 1904. She became its vice-president in 1929. The couple's last child was Jane Lister; she married widower Smith Harrison, a wholesale tea merchant.
After their marriage, the Listers lived at 5 Tokenhouse Yard in Central London for three years until 1822, where they ran a port wine business in partnership with Thomas Barton Beck.
Beck was the grandfather of the professor of surgery and proponent of the germ theory of disease, Marcus Beck, who would later promote Lister's discoveries in his fight to introduce antiseptics. In 1822, Lister's family moved to Stoke Newington. In 1826, the family moved to Upton House, a long low Queen Anne style mansion that came with 69 acres of land. It had been rebuilt in 1731, to suit the style of the period.
Education
School
As a child, Lister had a stammer and this was possibly why he was educated at home until he was eleven. Lister then attended Isaac Brown and Benjamin Abbott's Academy, a private Quaker school in Hitchin, Hertfordshire. When Lister was thirteen, he attended Grove House School in Tottenham, also a private Quaker School 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. From an early age, Lister was strongly encouraged by his father and would talk about his father's great influence later in life, particularly in encouraging him in his study of natural history. 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 and then drawn using the camera lucida technique that his father had explained to him, or sketched. His father's interests in microscopical research developed in Lister the determination to become a surgeon and prepared him for a life of scientific research. 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.
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, 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. Lister took the public examination in the junior class of botany, a required course that would enable him to matriculate. Lister left school in the spring of 1844 when he was seventeen.
In 1844, just before Lister's seventeenth birthday, he moved to an apartment at 28 London Road that he shared with Edward Palmer, also a Quaker. Between 1844 and 1845, Lister continued his pre-matriculation studies, in Greek, Latin and natural philosophy. In the Latin and Greek classes, he won a "Certificate of Honour". For the experimental natural philosophy class, Lister won first prize and was awarded a copy of Charles Hutton's "Recreations in Mathematics and Natural Philosophy".
Although his father wanted him to continue his general education, the university had demanded since 1837, that each student obtain a Bachelor of Arts (BA) degree before commencing medical training. Lister matriculated in August 1845, initially studying for a BA in classics. Between 1845 and 1846, Lister studied the mathematics of natural philosophy, mathematics and Greek earning a "Certificate of Honour" in each class. Between 1846 and 1847, Lister studied both anatomy and atomic theory (chemistry) and won a prize for his essay. On 21 December 1846, Lister and Palmer attended Robert Liston's famous operation where ether was applied by Lister's classmate, William Squire to anaesthetise a patient for the first time. On 23 December 1847, Lister and Palmer moved to 2 Bedford Place and were joined by John Hodgkin, the nephew of Thomas Hodgkin who discovered Hodgkin lymphoma. Lister and Hodgkin had been school friends.
In December 1847, Lister graduated with a degree of Bachelor of Arts 1st division, with a distinction in classics and botany. While he was studying, Lister suffered from a mild bout of smallpox, a year after his elder brother died of the disease. The bereavement combined with the stress of his classes led to a nervous breakdown in March 1848. Lister's nephew Godlee used the term to describe the situation and is perhaps indicative that adolescence was just as difficult in 1847, as it is now. Lister decided to take a long holiday to recuperate and this delayed the start of his studies. In late April 1848, Lister visited the Isle of Man with Hodgkin and by 7 June 1848, he was visiting Ilfracombe. At the end of June, Lister accepted an invitation to stay in the home of Thoman Pim, a Dublin Quaker. Using it as his base, Lister travelled throughout Ireland. On 1 July 1848, Lister received a letter full of warmth and love from his father where his last meeting was "...sunshine after a refreshing shower, following a time of cloud" and advised him to "cherish a pious cheerful spirit, open to see and to enjoy the bounties and the beauties spread around us :—not to give way to turning thy thoughts upon thyself nor even at present to dwell long on serious things". From 22 July 1848, for more than a year, the record is blank.
Lister registered as a medical student in the winter of 1849 and became active in the University Debating Society and the Hospital Medical Society. In the autumn of 1849, he returned to college with a microscope given to him by his father. After completing courses in anatomy, physiology and surgery, he was awarded a "Certificate of Honours", winning the silver medal in anatomy and physiology and a gold medal in botany.
His main lecturers were John Lindley professor of botany, Thomas Graham professor of chemistry, Robert Edmond Grant professor of comparative anatomy, George Viner Ellis professor of anatomy and William Benjamin Carpenter professor of medical jurisprudence. Lister often spoke highly of Lindley and Graham in his writings, but Wharton Jones professor of ophthalmic medicine and surgery, and William Sharpey professor of physiology, exercised the greatest influence on him. He was greatly attracted by Dr. Sharpey's lectures, which inspired in him a love of experimental physiology and histology that never left him.
Thomas Henry Huxley praised Wharton Jones for the method and quality of his physiology lectures. As a clinical scientist working in physiological sciences, he was foremost in the number of discoveries he made. He was also considered a brilliant ophthalmic surgeon, his main field. He conducted research into the circulation of blood and the phenomena of inflammation, carried out on the frog's web and the bat's wing, and no doubt suggested this method of research to Lister. Sharpey was called the father of modern physiology as he was the first to give a series of lectures on the subject. Prior to that the field had been considered part of anatomy. Sharpey studied at Edinburgh University, then went to Paris to study clinical surgery under French anatomist Guillaume Dupuytren and operative surgery under Jacques Lisfranc de St. Martin. Sharpey met James Syme while in Paris and the two became life-long friends. After he moved to Edinburgh he taught anatomy with Allen Thomson as his physiological colleague. He left Edinburgh in 1836, to become the first Professor of Physiology.
To qualify for his degree, Lister had to complete two years of clinical instruction, and began his residency at University College Hospital in October 1850. as an intern and then house physician to Walter Hayle Walshe, professor of pathological anatomy and author of the 1846 study, The Nature and Treatment of Cancer. Lister in 1850 again received "Certificates of Honours" and won two gold medals in anatomy and a silver medal each in surgery and medicine.
In his second year in 1851, Lister became first a dresser in January 1851 then a house surgeon to John Eric Erichsen in May 1851. Erichsen was professor of surgery and author of the 1853 Science and Art of Surgery, described as one of the most celebrated English-language textbooks on surgery. The book went through many editions; Marcus Beck edited the eighth and ninth, adding Lister's antiseptic techniques and Pasteur and Robert Koch's germ theory.
Lister's first case notes were recorded on 5 February 1851. As a dresser, his immediate superior was Henry Thompson, who recalled "..a shy Quaker...I remember that he had a better microscope than any man in the college".
Lister had only just begun working in his role as dresser to Erichsen in January 1851, when an epidemic of erysipelas broke out in the male ward. An infected patient from an Islington workhouse was left in Erichsen's surgical ward for two hours. The hospital had been free of infection but within days there were twelve cases of infection and four deaths. In his notebook, Lister stated that the disease was a form of surgical fever, and particularly noted that recent surgical patients were infected the worst, but that those with older surgeries with suppurating wounds, 'mostly escaped'. It was while Lister worked for Erichsen, that his interest in the healing of wounds began. Erichsen was a miasmatist who thought the wounds became infected from miasmas from the wound itself that caused a noxious form of "bad air" that spread to other patients in the ward. Erichsen believed that seven patients with an infected wound had saturated of the ward with "bad air", which spread to cause gangrene. However Lister saw that some wounds, when debrided and cleaned, would sometimes heal. He believed that something in the wound itself was at fault.
When he became a house surgeon, Lister had patients put in his charge. For the first time, he came into contact face-to-face with various forms of blood-poisoning diseases like pyaemia and hospital gangrene, which rots living tissue with a remarkable rapidity. While examining in an autopsy an excision of the elbow of a little boy who had died of pyaemia, Lister noticed that a thick yellow-pus was present at the seat of the humerus bone, and distended the brachial and axillary veins. He also noticed that the pus advanced in the reverse direction along the veins, bypassing the valves in the veins. He also found suppuration in a knee-joint and multiple abscesses in the lungs. Lister knew that Charles-Emmanuel Sédillot had discovered that multiple abscesses in the lungs were caused by introducing pus into the veins of an animal. At the time he could not explain the facts but believed the pus in the organs had a metastatic origin. On 2 October 1900, during The Huxley Lecture, Lister described how his interest in the germ theory of disease and how it applied to surgery began with his investigation into the death of that little boy.
There was an epidemic of gangrene during his surgeoncy. The treatment method was to chloroform the patient, scrape the soft slough off and burn the necrotic flesh away with mercury pernitrate Occasionally the treatment would succeed, but when a grey film appeared at the edges of the wound, it presaged death. In one patient, the repeated treatment failed several times, so Erichsen amputated the limb, which healed fine. Lister recognised was that the disease was a "local poison" and probably parasitic in nature. He examined the diseased tissues under his microscope. He saw peculiar objects that he could not identify, as he had no frame of reference to draw conclusions from these observations. In his notebook he recorded:
I imagined they might be the materies morbi in the form of some kind of fungus.
Lister wrote two papers on the epidemics; but both were lost: Hospital gangrene and Microscope. They were read to the Student Medical Society at UCL.
Lister's first operation
On 26 June 2013, medical historian Ruth Richardson and orthopaedic surgeon Bryan Rhodes published a paper in which they described their discovery of Lister's first operation, made while both were researching his career. At 1 pm on 27 June 1851, Lister, a second-year medical student working at a casualty ward in Gower Street, conducted his first operation. Julia Sullivan, a mother of eight grown children, had been stabbed in the abdomen by her husband, a drunk and ne'er-do-well, who was taken into custody. On 15 September 1851, Lister was called as a witness to the husband's trial at the Old Bailey. His testimony helped convict the husband, who was transported to Australia for 20 years.
About a yard of small intestine about eight inches across, damaged in two places, protruded from the woman's lower abdomen, which had three open wounds. After cleaning the intestines with blood-warm water, Lister was unable to place them back into the body, so he decided to extend the cut. He then placed the intestines back into the abdomen, and sewed and sutured the wounds shut. He administered opium to induce constipation and enable the intestines to recover. Sullivan recovered her health. This was a full decade before his first public operation in the Glasgow Infirmary.
This operation was missed by historians. Liverpool consultant surgeon John Shepherd, in his essay on Lister, Joseph Lister and abdominal surgery, written in 1968, failed to mention the operation, and instead started his account from the 1860s onwards. He apparently was unaware of this surgery.
Microscope experiments 1852
Contractile Tissue of the Iris
Lister's first paper "Observations on the Contractile Tissue of the Iris" was written while he was still at university and published in the Quarterly Journal of Microscopical Science in 1853.
On 11 August 1852, Lister attended an operation at University College Hospital by Wharton Jones, who presented him with a fresh slice of human iris. Lister took the opportunity to study the iris. He reviewed existing research and studied tissue from a horse, a cat, a rabbit and a guinea pig as well as six surgical specimens from patients who had undergone eye surgery. Lister was unable to complete his research to his satisfaction, due to his need to pass his final examination. He offered an apology in the paper:
My engagements do not allow me to carry the inquiry further at present; and my apology for offering the results of an incomplete investigation is that a contribution tending, in however small a degree, to extend our acquaintance with so important an organ as the eye, or to verify observations that may be thought doubtful, may probably be of interest to the physiologist.
The paper advanced the work of Swiss physiologist Albert von Kölliker, demonstrating the existence of two distinct muscles, the dilator and sphincter in the iris. This corrected the convictions of previous researchers that there was no dilator pupillae muscle.
Muscular Tissue of the Skin
His next paper "Observations on the Muscular Tissue of the Skin" was an investigation into goose bumps, that was published on 1 June 1853 in the same journal. Lister was able to confirm Kölliker's experimental finding that in humans the smooth muscle fibres are responsible for making hair stand out from the skin, in contrast to other mammals, whose large tactile hairs are associated with striated muscle. Lister also demonstrated a new method of creating histological sections from the tissue of the scalp.
Lister's microscopy skills were so advanced that he was able to correct the observations of German histologist Friedrich Gustav Henle, who mistook small blood vessels for muscle fibres. In each of the papers, he created camera lucida drawings so accurate that they could be used to scale and measure the observations.
Both papers attracted significant attention in Britain and abroad. Naturalist Richard Owen, an old friend of Lister's father, was particularly impressed by them. Owen contemplated recruiting Lister for his department and forwarded him a thank-you letter on 2 August 1853. Kölliker was particularly pleased with the analysis that Lister had formulated. Kölliker made many trips to Britain, and eventually met Lister. They became life-long friends. Their close friendship was described in a letter by Kölliker on 17 November 1897, that Rickman Godlee chose to use to illustrate their relationship. Kölliker sent a letter to Lister when he was president of the Royal Society, congratulating him on receiving the Copley medal, fondly remembering old friends who had died, and celebrating his time in Scotland with Syme and Lister. Kölliker was 80 years old at the time.
Graduation
Lister graduated with a Bachelor of Medicine with honours in the autumn of 1852. During his final year, Lister won several prestigious awards heavily contested among the student body of London teaching hospitals. He won the Longridge Prize
For the greatest proficiency evinced during the three years immediately preceding, on the Sessional Examinations for Honours in the classes of the Faculty of Medicine of the College; and for creditable performance of duties of offices at the Hospital
that included a £40 stipend. He was also awarded a gold medal in structural and physiological botany. Lister won two of the four available gold medals in anatomy and physiology as well as surgery, which came with a scholarship of £50 a year for two years, for his second examination in medicine. In the same year, Lister passed the examination for the fellowship of the Royal College of Surgeons, bringing to a close nine years of education.
Sharpey advised Lister to spend a month at the medical practice of his lifelong friend James Syme in Edinburgh and then visit medical schools in Europe for a longer period for training. Sharpey himself had been taught first in Edinburgh and later in Paris. Sharpey had met Syme, a teacher of clinical surgery widely considered the best surgeon in the United Kingdom while he was in Paris. Sharpey had gone to Edinburgh in 1818, along with many other surgeons since, due to the influence of John Hunter. Hunter had taught Edward Jenner, seen as the first surgeon to take a scientific approach to the study of medicine, known as the Hunterian method Hunter was an early advocate for careful investigation and experimentation, using the techniques of pathology and physiology to give himself a better understanding of healing than many of his colleagues. For example, his 1794 paper, A treatise on the blood, inflammation and gun-shot wounds was the first systematic study of swelling, discovering that inflammation was common to all diseases. Due to Hunter, surgery, then practised by hobbyists or amateurs, became a true scientific profession. As the Scottish universities taught medicine and surgery from a scientific viewpoint, surgeons who wished to emulate those techniques travelled there for training. Scottish universities had several other features that distinguished them from those in the south. They were inexpensive and did not require religious admissions tests, and thus attracted the most scientifically progressive students in Britain. The most important differentiator was that medical schools in Scotland had evolved from a scholarly tradition, where English medical schools relied on hospitals and practice. Experimental science had no practitioners at English medical schools and while Edinburgh University medical school was large and active at the time, southern medical schools were generally moribund, and their laboratory space and teaching materials inadequate. English medical schools also tended to view surgery as manual labour, not a respectable calling for a gentleman academic.
Surgical profession 1854
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. 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.
Edinburgh 1853–1860
James Syme
Syme, a well-established clinical lecturer at Edinburgh University for more than two decades before he met Lister, was considered the boldest and most original surgeon then living in Great Britain. He became a surgical pioneer during his career, preferring simpler surgical procedures, as he detested complexity, in the era that immediately preceded the introduction of anaesthesia.
In September 1823, at the age of 24, Syme made a name for himself by first performing an amputation at the hip-joint, the first in Scotland. Considered the bloodiest operation in surgery, Syme completed it in less than a minute, as speed was essential at that time, before anaesthesia. Syme became widely known and acclaimed for developing a surgical operation that became known as Syme amputation, an amputation at the ankle where the foot is removed and the heel pad is preserved. Syme was considered a scientific surgeon, as evidenced by his paper On the Power of the Periosteum to form New Bone, and became one of the first advocates of antiseptics.
Arrival in Edinburgh
In September 1853, Lister arrived in Edinburgh bearing letters of introduction from Sharpey to Syme. 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 him in his private operations.
Lister was invited to Syme's house Millbank in Morningside (now part of Astley Ainslie Hospital), where he met, amongst others, Agnes Syme, Syme's daughter from another marriage and granddaughter of physician Robert Willis. While Lister thought that Agnes was not conventionally pretty, he admired her quickness of mind, her familiarity with medical practice, and her warmth. He became a frequent visitor to Millbank and met a much wider group of eminent people than he would have in London.
