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JOSEPH LISTER LISTER

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Originally appearing in Volume V16, Page 779 of the 1911 Encyclopedia Britannica.
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JOSEPH See also:LISTER LISTER  , 1st See also:BARON (1827– ), See also:English surgeon, was See also:born at Upton, in See also:Essex, on the 5th of See also:April 1827 . His See also:father, See also:Joseph See also:Jackson See also:Lister, F.R.S., was eminent in See also:science, especially in See also:optical science, his See also:chief claim to remembrance being that by certain improvements in lenses he raised the See also:compound See also:microscope from the position of a scientific See also:toy, " distorting as much as it magnified," to its See also:present See also:place as a powerful See also:engine of See also:research . Other members of See also:Lord Lister's See also:family were eminent in natural science . In his boyhood Joseph Lister was educated at Quaker See also:schools; first at See also:Hitchin in See also:Hertfordshire, and afterwards at See also:Tottenham, near See also:London . In 1844 he entered University See also: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 See also:young student was not See also:long in bringing his faculties to See also:bear upon See also:pathology and the practice of See also:medicine . While See also:house-surgeon at University College See also:Hospital, he had See also:charge of certain cases during an out-break of hospital See also:gangrene, and carefully observed the phenomena of the disease and the effects of treatment upon it . He was thus See also:early led to suspect the parasitic nature of the disorder, and searched with the microscope the material of the spreading sore, in the See also:hope of discovering in it some invading fungus; he soon convinced himself of the See also:cardinal truth that its causes were purely See also:local . He also minutely investigated cases of pyaeraia, another terrible See also:scourge of hospitals at that See also:time, and made See also:camera lucida sketches of the appearances revealed by the microscope . To realize Lister's See also:work it is necessary to remember the See also:condition of surgical practice at that date . About the See also:middle of the loth See also:century the introduction of anaesthetics had relieved the patient of much of the horror of the See also:knife, and the surgeon of the See also:duty of See also:speed in his work .

The agony of the sufferer had naturally and rightly compelled the public to demand rapid if not slap-dash See also:

surgery, and the surgeon to See also:pride himself on it . Within decent limits of precision, the quickest craftsman was the best . With anaesthetics this See also:state of things at any See also:rate was changed . The See also: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, See also:pro-found and intricate operations which before had been out of the question . Yet unhappily this new enfranchisement seemed to be but an ironical See also:liberty of Nature, who with the other See also:hand took away what she had given . See also:Direct healing of surgical wounds (" by first intention "), far from being the See also:rule, was a piece of See also:luck too rare to enter into the calculations of the operator; while of the graver surgical undertakings, however successful mechanica?'y, the mortality by See also:sepsis was ghastly . Suppuration, phagedaena and septic poisonings of the See also:system carried away even the most promising patients and followed even trifling operations . Often, too, these diseases See also: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 See also:craft . New hospitals or new wards were built, yet after a very See also:short time the new became as pestiferous as the old; and even scrupulous care in See also:ventilation and housemaids' cleanliness failed to prevent the devastation . Surgery had enlarged its freedom, but only to find the See also:weight of its new responsibilities more than it could bear . When Lister was appointed to the See also:chair of surgery in See also:Glasgow the infirmary of that See also: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 crards .

The See also:

building stands to-See also:day as it stood then, with no substantial alteration; but by the See also:genius of Lister its surgical wards are now as See also:free from septic accidents as the most See also:modern hospital in the See also:land . See also:James See also: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 See also:lay hidden, but in the operator himself, his tools and his assistants . Happily this beneficent See also: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 See also:speculation was on the wrong tack; the See also:oxygen of, the See also:air was then supposed to be the chief cause of the See also:dissolution of the tissues, and to prevent See also:access of air was impossible . For instance, a See also:simple fracture, as of a See also:bone of the See also:leg, would do perfectly well, while in the very next See also: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 See also:limb were amputated, a large proportion of such cases of amputation succumbed to septic poisoning . On See also:graduation as See also:bachelor of medicine, Lister went to See also:Edinburgh, where he soon afterwards became house-surgeon to Mr See also:Syme; and he was much impressed by the skill and See also:judgment of this See also:great surgeon, and also by the superiority of his method of dressing See also:recent wounds with dry See also:lint, as compared with the " See also:water dressing " in use at University College . Yet under these more favourable conditions the amelioration was only one of degree; in most wounds indeed " See also:union by first intention " was rendered impossible by the presence of the See also:silk ligatures employed for arresting bleeding, for these could come away only by a See also:process of suppuration . On the expiry of his housesurgeoncy in Edinburgh, Lister started in that city an extra-academical course of lectures on surgery; and in preparation for these he entered on a See also:series of investigations into inflammationand 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 See also:developed the aseptic method of surgery, he would have taken a very high place in pathology .

In his speech in See also:

Paris at the Thirteenth See also:International See also:Congress of Medicine in 1900, Lord Lister said that he had done no more than seize upon See also: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 See also:minute forms of See also:vegetable See also:life See also:spring always, like higher See also:organ-isms, from parents like themselves, and cannot arise de nova in the See also:animal See also:body . After his See also:appointment to the Glasgow chair in 186o, Lister had continued his researches on inflammation; and he had long been led to suspect that decomposition of the See also:blood in the See also:wound was the See also: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 See also: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 See also:attempt to realize this See also:idea was made upon compound fractures; and the means first employed was carbolic See also: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 See also:form with the blood a dense crust, the See also: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 See also:British Association in See also:Liverpool, he " had the joy of seeing these formidable injuries follow the same safe and tranquil course as simple fractures." The See also:caustic See also:property of undiluted carbolic acid, though insignificant in comparison with the far greater evils to be avoided in compound fracture, made it unsuited for See also:general surgery . To make it applicable to the treatment of abscesses and incised wounds, it was necessary to mitigate its See also:action by blending it with some inert body; and the endeavour to find the best See also: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 See also:ward . At one See also:stage in these inquiries an attempt was made to provide an See also:atmosphere free from living organisms by means of a See also:fine spray of a watery See also:solution of carbolic acid; for it was then supposed by Lister to be necessary not only to purify the surgeon's hands and See also:instruments and the skin of the patient about the seat of operation, but also to wage See also:war with the microbes which, as Pasteur had shown, See also:people every cubic See also:inch of the air of an inhabited See also:room . Under the use of the spray better results were obtained than ever before, and this success encouraged its use .

Phoenix-squares

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 See also:

soil for the development of the bacteria diffused through the air, and others which showed that the cells of an organizing blood-See also:clot have a very remarkable See also: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 See also:matter of See also:probability, he did not dare to discard the spray . But at length, at the See also:Berlin Congress in 1890, he was able to announce that the certainty he had so long desired had been arrived at . A careful See also:consideration of the See also:physical ' See Trans. of the International Medical Congress (1881), vol. ii . P . 373• 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 See also:case, the See also: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 See also:left entirely out of consideration in operating.' Thus he learnt 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 See also:irrigation . And Lister took care to emphasize the See also:necessity for redoubled vigilance on the See also: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 endeavour to apply the antiseptic principle to the best See also:advantage, and abandoned in favour of something better .

Two main See also:

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 See also: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 See also:original ideas . To illustrate this See also:opinion, his work on the ligature may be taken . It had long been the universal practice of surgeons to employ threads of silk or See also:flax for tying See also:arteries, long ends being left to provide See also: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 See also:knot . Lister hoped that if, by antiseptic means, the See also: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 See also:primary union throughout . A trial of this method upon the See also:carotid artery of a See also:horse having proved perfectly successful, he applied it in a case of See also:aneurysm in the human subject; and here again the immediate results were all that could be desired . But a See also: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 See also: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 . See also:Catgut, which is prepared from one of the constituents of the small See also:intestine of the See also:sheep, after steeping in a solution of carbolic acid, was used in a preliminary trial upon the carotid artery of a See also:calf . The animal was killed a See also:month later, when, on See also:dissection, a very beautiful result was disclosed . The catgut, though removed, had not been simply absorbed; pari passu with its See also: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 ' See Verhandlungen See also:

des X internationalen Congresses, Bd. i. p . 33.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 See also:special preparation to obtain an See also:article in all respects See also:trust-worthy engaged his See also:attention from time to time for years after-wards . To quote the words of See also:Sir See also:Hector See also:Cameron, who was for several years assistant to Lord Lister, it required " labour and toilsome investigation and experiment of which few can have any adequate idea." In 1869 Lister succeeded his father-in-See also:law, Syme, in the chair of clinical surgery of Edinburgh . In 1877 he accepted an invitation to the chair of surgery at See also:King's College, London, in the anticipation that here he would be more centrally placed for communication with the surgical See also:world at See also:home and abroad, and might thus exercise his beneficent See also:mission to more immediate advantage . In 1896 Lister retired from practice, but not from scientific study . From 1895 to 1900 he was See also:President of the Royal Society . In 1883 he was created a See also:baronet, and in 1897 he was raised to the See also:peerage as Baron Lister of Lyme Regis . Among the See also:Coronation honours in 1902, he was nominated an original member of the new See also:Order of Merit . In See also:England Lister's teaching was slow in making its way . The leading surgeons of See also:Germany were among the first to seize upon the new idea with avidity and See also:practical success; so early as 1875, in the course of a tour he made on the See also:Continent, great festivals were held in his See also:honour in See also:Munich and See also:Leipzig .

The countrymen of Pasteur did not lag far behind; and it is no exaggeration to speak of Lister's appearances in See also:

foreign countries at this time as triumphal . The relation of See also:Semmelweiss to Lister is of See also:historical importance . Lister's work on- the antiseptic system began in 1864; his first publication on the subject was in See also:March 1867 . At this date, and for long afterwards, Semmelweiss was unknown, or ignored, not only by See also:French and Germans, but also by his own Hungarian people; and this neglect See also:broke his See also:heart . The French See also:Academy pronounced against his opinions, and so did the highest pathological authority in Germany . In England, till long after his See also:death, probably his name was not so much as mentioned . In the early 'seventies Lister's method was in full operation in See also:Hungary as elsewhere, yet none of the surgeons of See also: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 See also: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 Lord Lister's speeches were simple, clear and graceful, avoiding rhetorical display, See also:earnest for the truth, jealous for his science and See also:art, forgetful of himself . His writings, in like manner See also:plain, lucid and forcible, scarcely betray the labour and thought of their See also:production . With the See also:courtesy and serenity of his See also:carriage he combined a passionate humanity, so often characteristic of those who come of the Society of See also:Friends, and a simple love of truth which showed itself in his generous encouragement of younger workers .

(T . C .

End of Article: JOSEPH LISTER LISTER
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