CHAPTER XVII

ANTISEPTIC SURGERY: LORD LISTER

JOSEPH LISTER, the story of whose achievements in surgery is so closely associated with that of the development of bacteriology, was born in the London district (Upton) April 5, 1827. He received his early schooling at two Quaker institutions (his family belonging to the Society of Friends), took his bachelor's degree at University College, London, proceeded at the age of twenty-one to his professional education at the University College Hospital and Medical School, and at the age of twenty-five received the M.B. and F.R.C.S. He had already come in contact with several men whose names are known in the history of science: Joseph Jackson Lister, his father, already referred to as contributing to the production of the achromatic lens; Thomas Graham, who formulated the law of the diffusion of gases; W. B. Carpenter, whose work on "Mental Physiology" has had a great effect on the progress of psychology; William Jenner, who during Lister's early years as a student of medicine was working out the distinction between typhus fever and typhoid; William Sharpey, the distinguished teacher of physiology; and Wharton Jones, noted as an

ophthalmic surgeon and as one of the pioneers, in England, in the study of embryology. Before taking his degrees in medicine Lister had served six months as house physician and nine months as house surgeon (to Erichsen) at the University College Hospital.

Among the results of his extended education were a considerable command of ancient and modern languages, skill as a draughtsman and microscopist, love of scientific truth and a taste for research. In 1853, the year following his graduation in medicine, he published two papers in the "Quarterly Journal of Microscopical Science." The first of these recorded the discovery of the sphincter and the dilator of the iris as distinct muscles, and confirmed the views of Kölliker as regards the nonstriated and the cellular structure of the tissue in question. The second paper, illustrated like the first by delicate drawings, dealt with the arrectores pili, especially those of the scalp. He prepared his sections by tying the tissue to be examined between two thin slips of pine and allowing it to dry for twenty-four hours, by which time the piece of scalp having adhered to one of the slips could be cut, by means of a sharp razor, in very fine shavings along with the wood in any plane desired. This was an original form of microtome.

In the autumn of 1853 Lister went to Edinburgh,

on the advice of Sharpey, in order to attend the surgical clinics of Syme, an excellent teacher and the foremost surgeon at that time in Great Britain. The young man was very cordially received. He became a frequent visitor in Syme's home, where he met a large number of agreeable and cultured people, among them Dr. John Brown, the author of "Rab and his Friends." In the congenial society of Edinburgh, a city more beautiful then even than now, Lister threw off much of his natural shyness and restraint, though, in spite of the favor his accomplishments and admirable disposition gained for him, he never lost his native modesty. He soon became Syme's house surgeon at the Royal Infirmary, where in this period following the introduction of the use of anæsthetics, he had abundant opportunities to develop skill as an operator. About this time he wrote home: "If the love of surgery is a proof of a person's being adapted for it, then certainly I am fitted to be a surgeon; for thou canst hardly conceive what a high degree of enjoyment I am from day to day experiencing in this bloody and butcherly department of the healing art." The young house surgeon had twelve dressers, who called him "The Chief," a title he retained for life among his many loyal disciples. In the autumn of 1855 he gave an extra-mural course of lectures on surgery. In the following spring he married Syme's

daughter Agnes. A three months' tour of the Continent followed, during which the young couple met Rokitansky, Albrecht von Graefe, and other distinguished people. In the autumn of 1856, after their return to Edinburgh, Lister was appointed assistant surgeon at the Royal Infirmary.

Among the many papers prepared by him during these early years in Edinburgh the most important is that on "The Early Stages of Inflammation," read before the Royal Society of London in 1857. It was the product of a long series of investigations, probably suggested by some studies of Wharton Jones. Lister's conclusions were based on an experimental study of the circulation in the web of the frog's foot and of the bat's wing. He had begun his experiments on the frog in September, 1855. In a letter written at that time he says: "Mr. Sparshott, the most intelligent of the last set of dressers, and who is to attend my lectures in the winter, kindly assisted me, and a glorious night I had of it. I had the frog so placed and fixed that I could inject anything upon the web under the microscope from a syringe, and it so happened that the frog was not only perfectly healthy, but with remarkably little pigment, and exceedingly quiet. By using a 2/3 object-glass I had a fine large field of view, and had under observation always the same artery, with the field of capillaries into which it divided and the two

veins which returned the blood from them; and thus was able to watch with great precision the effects produced; the animal rarely struggling at all." Under these conditions he began by applying to the web warm water, which first checked and then stimulated the circulation. He followed up this procedure by applying water of higher and higher temperature till the boiling point was approached. Finally the capillaries were greatly "distended and stuffed with the red corpuscles, and the blood was first retarded, then stagnant."

Lister continued these studies of the circulation by a series of obervations and experiments concerning a closely related subject, namely, the coagulation of the blood. A case of so-called spontaneous gangrene, in which he had been forced to resort to amputation, led him to the conclusion that obstruction to the circulation had been caused primarily by a diseased condition of the vessels. This case was reported in the early part of the year 1858 (just when Virchow was giving his lectures in Berlin on "Cellular Pathology"). At the same time Lister reported that he had drawn off the blood of a sheep into a vulcanized rubber tube, which he then divided into a number of closed compartments, and that the blood remained fluid for three hours. When the blood was allowed to escape from the tube, it coagulated, of course, in about three minutes, just