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Father of antiseptic surgery, first to wire fractures, developed dissolving sutures
"I am a believer in the fundamental doctrines of Christianity"

Since the antiseptic treatment has been brought into full operation, and wounds and abscesses no longer poison the atmosphere with putrid exhalations, my wards...have completely changed their character; so that during the last nine months not a single instance of pyraemia, hospital gangrene or erysipelas has occurred in them.

I remember reading how the town authorities in the little town of Carlisle, rendered their sewage sweet smelling, by treating with carbolic acid. And I wondered. Patients with compound fractures, fractures where the skin of the fracture site is broken nearly always died of sepsis. I had an idea, an hypothesis-perhaps infected fractures were like sewage.

And now, before proceeding further, I desire to correct a mistake into which I fell when investigating this same fermentation some years ago; for, next to the promulgation of a new truth, the best thing, I conceive, that a man can do, is the recantation of published error.

Joseph Lister
Born: 5-Apr-1827
Birthplace: Upton, Essex, England
Died: 10-Feb-1912
Location of death: Walmer, Kent, England
Cause of death: unspecified

Occupation: Doctor; Pioneer of antiseptic surgery

English surgeon, born at Upton, in Essex, on the 5th of April 1827. His father, Joseph Jackson Lister, F.R.S., was eminent in science, especially in optical science, his chief claim to remembrance being that by certain improvements in lenses he raised the compound microscope from the position of a scientific toy, "distorting as much as it magnified", to its present place as a powerful engine of research. Other members of Lister's family were eminent in natural science. In his boyhood Joseph Lister was educated at Quaker schools; first at Hitchin in Hertfordshire, and afterwards at Tottenham, near London. In 1844 he entered University College, London, as a student in arts, and took his B.A. degree at the University of London in 1847. He continued at University College as a medical student, and became M.B. and F.R.C.S. in 1852. The keen young student was not long in bringing his faculties to bear upon pathology and the practice of medicine. While house-surgeon at University College Hospital, he had charge of certain cases during an outbreak of hospital gangrene, and carefully observed the phenomena of the disease and the effects of treatment upon it. He was thus early led to suspect the parasitic nature of the disorder, and searched with the microscope the material of the spreading sore, in the hope of discovering in it some invading fungus; he soon convinced himself of the cardinal truth that its causes were purely local. He also minutely investigated cases of pyaemia, another terrible scourge of hospitals at that time, 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 today 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 1860s, 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 James 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 favorable 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, Lister said that he had done no more than seize upon Louis 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 until 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 endeavor 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 microorganisms 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 he disregarded altogether. 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 constitution of the spray had shown him that the microbes of the dust involved in its vortex could not possibly have their vitality destroyed or even impaired by it. Such being the case, the uniform success obtained when he had trusted the spray implicitly as an aseptic atmosphere, abandoning completely certain other precautions which he had before deemed essential, proved conclusively to his mind that the air might safely be left entirely out of consideration in operating. Thus he learned that not the spray only, but all antiseptic irrigations or washings of the wound also, with their attendant irritation of the cut surfaces, might be dispensed with -- a great simplification, indirectly due to experiments with the spray. The spray had also served a very useful purpose by maintaining a pure condition of the entourage of the operation; not indeed in the way for which it was devised, but as a very mild form of irrigation. And Lister took care to emphasize the necessity for redoubled vigilance on the part of the surgeon and his assistants when this "unconscious caretaker", as he called it, had been discarded.

The announcement that he had given up the spray was absurdly interpreted in some quarters to mean that he had virtually abandoned his theory and his antiseptic methods. The truth is that the spray was only one of many devices tried for a while in the course of the long-continued endeavor to apply the antiseptic principle to the best advantage, and abandoned in favor of something better. Two main objects were always kept steadily in view by him -- during the operation to guard the wound against septic microbes by such means as existing knowledge indicated, and afterwards to protect it against their introduction, avoiding at the same time all needless irritation of the tissues by the antiseptic. Upon the technical methods of attaining these ends this is not the place to enlarge; suffice it to say that the endowments and the industry of the discoverer, as seen in the rapidity and flexibility of mind with which he seized upon and selected the best means, were little less remarkable than the activity of the same faculties in his original ideas.

To illustrate this opinion, his work on the ligature may be taken. It had long been the universal practice of surgeons to employ threads of silk or flax for tying arteries, long ends being left to provide escape of the pus (invariably formed during the tedious process of the separation of the ligature) together with the portion of the arterial coats included in the knot. Lister hoped that if, by antiseptic means, the thread were deprived of living microbes, it would no longer cause suppuration, but might be left with short cut ends to become embedded permanently among the tissues of the wound, which thus would be allowed to heal by primary union throughout. A trial of this method upon the carotid artery of a horse having proved perfectly successful, he applied it in a case of aneurysm in the human subject; and here again the immediate results were all that could be desired. But a year later, the patient having died from other causes, the necropsy showed remnants of the silk thread incompletely absorbed, with appearances around them which seemed to indicate that they had been acting as causes of disturbance. Thus was suggested to him the idea of employing for the ligature some material susceptible of more speedy absorption; and the antiseptic treatment of contused wounds having shown that dead tissue, if protected from putrefaction, is removed by the surrounding structures without the intervention of suppuration, he resolved to try a thread of some such nature. Catgut, which is prepared from one of the constituents of the small intestine of the sheep, after steeping in a solution of carbolic acid, was used in a preliminary trial upon the carotid artery of a calf. The animal was killed a month later, when, on dissection, a very beautiful result was disclosed. The catgut, though removed, had not been simply absorbed; pari passu with its gradual removal, fibrous tissue of new formation had been laid down, so that in place of the dead catgut was seen a living ligature embracing the artery and incorporated with it. The wound meanwhile had healed without a trace of suppuration. This success appeared to justify the use of the catgut ligature in the human subject, and for a while the results were entirely satisfactory. But though this was the case with the old samples of catgut first employed, which, as Lister was afterwards led to believe, had been "seasoned" by long keeping, it was found that when catgut was used fresh as it comes from the makers, it was unsuited in various ways for surgical purposes. The attempt by special preparation to obtain an article in all respects trustworthy engaged his attention from time to time for years afterwards. To quote the words of Sir Hector Cameron, who was for several years assistant to Lister, it required "labor and toilsome investigation and experiment of which few can have any adequate idea."

In 1869 Lister succeeded his father-in-law, Syme, in the chair of clinical surgery of Edinburgh. In 1877 he accepted an invitation to the chair of surgery at King's College, London, in the anticipation that here he would be more centrally placed for communication with the surgical world at home and abroad, and might thus exercise his beneficent mission to more immediate advantage. In 1896 Lister retired from practice, but not from scientific study. From 1895 to 1900 he was President of the Royal Society. In 1883 he was created a baronet, and in 1897 he was raised to the peerage as Baron Lister of Lyme Regis. Among the Coronation honors in 1902, he was nominated an original member of the new Order of Merit.

In England Lister's teaching was slow in making its way. The leading surgeons of Germany were among the first to seize upon the new idea with avidity and practical success; so early as 1875, in the course of a tour he made on the Continent, great festivals were held in his honor in Munich and Leipzig. The countrymen of Pasteur did not lag far behind; and it is no exaggeration to speak of Lister's appearances in foreign countries at this time as triumphal.

The relation of Ignaz Semmelweis to Lister is of historical importance. Lister's work on the antiseptic system began in 1864; his first publication on the subject was in March 1867. At this date, and for long afterwards, Semmelweiss was unknown, or ignored, not only by French and Germans, but also by his own Hungarian people; and this neglect broke his heart. The French Academy pronounced against his opinions, and so did the highest pathological authority in Germany. In England, until long after his death, probably his name was not so much as mentioned. In the early 1870s Lister's method was in full operation in Hungary as elsewhere, yet none of the surgeons of Budapest ever mentioned Semmelweiss; not even when, in 1883, they gave a great banquet to Lister. It was after this occasion that Dr. Duka, a Hungarian physician practising in London, wrote a biography of Semmelweiss, which he sent to Lister, and thus brought Semmelweiss before him for the first time. Thenceforth Lister generously regarded Semmelweiss as in some measure his forerunner; though Semmelweiss was not aware of the microbic origin of septic poisons, nor were his methods, magnificent as was their success in lying-in hospitals, suitable for surgical work.

In public Lister's speeches were simple, clear and graceful, avoiding rhetorical display, earnest for the truth, jealous for his science and art, forgetful of himself. His writings, in like manner plain, lucid and forcible, scarcely betray the labor and thought of their production. With the courtesy and serenity of his carriage he combined a passionate humanity, so often characteristic of those who come of the Society of Friends, and a simple love of truth which showed itself in his generous encouragement of younger workers.

Father: Joseph Jackson Lister
Mother: Isabella Harris
Wife: Agnes Syme (dau. of James Syme, m. 1856, d. 1892)

University: Bachelor of Medicine, University College London (1852, with honors)
Professor: Professor of Surgey, University of Glasgow
Professor: Chair of Clinical Surgery, King's College London (1877)

Royal College of Surgeons 1852
Royal Society President, 1895-1900
Copley Medal 1902
Order of Merit 1902

At the age of 25 he became a Bachelor of Medicine and entered the Royal College of Surgeons. In 1854, Lister became first assistant surgeon to James Syme (1799-1870), a leader of surgery in England. The two became close friends and Lister ended up marrying Syme's daughter Agnes, leaving the Quakers because his religion did not permit alliances with nonmembers.

After six years he got a professorship of surgery at Glasgow. At the time the usual explanation for wound infection was that the exposed tissues were damaged by chemicals in the air or via a stinking "miasma" in the air. The sick wards actually smelled bad, not due to a "miasma" but due to the rotting of wounds. Hospital wards were occasionally aired out at midday but Florence Nightingale's doctrine of fresh air was still science fiction then. Facilities for washing hands or the patient's wounds did not exist and it was even considered unnecessary for the surgeon to wash his hands before he saw a patient. This was strange because the work of Ignaz Philipp Semmelweis and Oliver Wendell Holmes were not heeded even though the parallel should have been obvious.

Lister became aware of a paper published by Louis Pasteur which showed that rotting and fermentation could occur without any oxygen if micro-organisms were present. Lister confirmed this with his own experiments. If micro-organisms were causing gangrene, the problem was how to get rid of them. Pasteur suggested three methods: to filter them out, to heat them up, or expose them to chemical solutions. The first two were inappropriate in a human wound so Lister experimented with the third.

Carbolic acid (phenol) had been in use as a means of deodorising sewage, so Lister tested the results of spraying instruments, the surgical incisions, and dressings with a solution of it. Lister found that carbolic acid solution swabbed on wounds markedly reduced the incidence of gangrene and subsequently published a series of articles on the Antiseptic Principle of the Practice of Surgery describing this procedure on March 16 1867 in the journal The Lancet.

He also made surgeons wear clean gloves and wash their hands before and after operations with 5% carbolic acid solutions. Instruments were also washed in the same solution and assistants sprayed the solution in the operating theatre.

Many of his contemporaries laughed at him but Lister was said to have never bothered to reply and only heaved an occasional sigh at the world's stupidity. His critics still believed in the theory of spontaneous generation.

Lister left Glasgow in 1869 returning to Edinburgh as successor to Syme as Professor of Surgery,at Edinburgh University and continued to develop improved methods of antisepsis and asepsis,]. His fame had spread by then and audiences of 400 often came to hear him lecture. He moved to King's College in London and became the second man in England to operate on a brain tumour. He also developed a method of repairing kneecaps with metal wire and improved the technique of mastectomy. His discoveries were greatly praised and he was made Baron Lister of Lyme Regis and became one of the twelve original members of the Order of Merit.

Lister retired from practice after his wife, who had long helped him in research, died in 1893 during one of the few vacations they allowed themselves. Studying and writing lost appeal for him and he sank into religious melancholy . Despite suffering a stroke, he still came into the public light from time to time. Edward VII came down with appendicitis two days before his coronation. The surgeons did not dare operate without consulting England's leading surgical authority. The king later told Lister "I know that if it had not been for you and your work, I wouldn't be sitting here today".

A British Institution of Preventive Medicine, previously named after Edward Jenner was renamed in 1899 in honour of Lister.

Two postage stamps were issued in September 1965 to honour Lister for his contributions to antiseptic surgery.

 

As the germ theory of disease became more widely accepted, it was realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Some consider Lister the father of modern antisepsis.

Listerine mouthwash is named after him for his work in antisepsis.

He credited Ignaz Semmelweis for earlier work in antiseptic treatment: "Without Semmelweis, my achievements would be nothing." [1]