This gave Mrs. Lister an opportunity to show her value. All his life Lister was prone to unpunctuality and to being late with preparations for his addresses, not because he was indifferent to the convenience of others or careless about the quality of his teaching, but because he became so engrossed in the work of the moment that he could not tear himself away from it so long as any improvement seemed possible. This same quality made him slow over his hospital rounds and often over operations, with the result that his own meal-times were most irregular and his assistants often had trouble to stay the pangs of hunger. This handicapped him in private practice and in some measure as a lecturer. He gave plenty of thought to his subjects, but rarely began to put thoughts in writing sufficiently in advance of his engagement. When he was in time with his written matter the credit was chiefly due to his wife. On the occasion of this paper she wrote for seven hours one day and eight hours the next, and her heroic industry saved the situation.
Towards the end of 1859 Lister decided to be a candidate for the Surgical Professorship at Glasgow, which appointment was in the gift of the Crown; and in spite of some intrigues to secure the patronage for a local man, the post was offered by the Home Secretary, Sir George Lewis, to the young Edinburgh surgeon. Syme's opinion and influence no doubt counted for much. Lister's appointment dated from January 1860, but it was not till a year and a half later that his position in Glasgow was assured by his being elected Surgeon to the Royal Infirmary. Before this he could preach his principles in the lecture-room, but he had little influence on the practice of his students and colleagues. Thanks to the reputation which he brought from Edinburgh, his first lecture drew a full room, and his class grew year by year till it reached the unprecedented figure of 182, and each year the enthusiasm seemed to rise. But in the hospital he had an uphill task, as any one will know who has studied the history of these institutions in the first half of the century.
To-day the modern hospital is an object of general admiration, with its high standard of cleanliness and efficiency; and few of us would have any hesitation if a doctor advised us to go into hospital for an operation. Seventy or a hundred years ago the case was very different; and when we read the statistics of the early nineteenth century, gathered by the surgeons who had known its horrors, it is hard to believe that we are not back among the worst abuses of the Middle Ages. Such terrible scourges as pyaemia and hospital gangrene were rife in all of them. In the chief hospital of Paris, which for centuries claimed pre-eminence for its medical faculty, the latter disease raged for 200 years without intermission: 25 per cent. of those entering its doors were found to have died, and the mortality after certain operations was more than double this figure. Erichsen, who published in 1874 the statistics of deaths after operations, quoted 25 per cent. in London as satisfactory, and referred to the 60 per cent. of Paris as not surprising. In military practice the number of deaths might reach the appalling figure of 80 or 90 per cent. What was so tragic about this situation was that it was precisely hospitals, built to be the safeguard of the community, which were the most dangerous places in the case of wounds and amputations. In 1869 Sir James Simpson, the famous discoverer of chloroform, collected statistics of amputations. He took over 2,000 cases treated in hospitals, and the same number treated outside. In the former 855 patients (nearly 43 per cent.) died, as it seemed, from the effects of the operation; in the latter only 266 cases (over 13 per cent.) ended fatally. He went so far as to condemn altogether the system of big hospitals; and under his influence a movement began for breaking them up and substituting a system of small huts, which, whether tending to security or not, was in other ways inconvenient and very expensive. About the same time certain other reforms, obvious as they seem to us since the days of Florence Nightingale, were tried in various places, tending to more careful organization and to greater cleanliness; but till the cause of the mischief could be discovered, only varying results could be obtained, and no real victory could be won. Hence a radical policy like Simpson's met with considerable support. In days when many surgeons submitted despairingly to what they regarded as inevitable, it was an advantage to have any one boldly advocating a big measure; and Simpson had sufficient prestige in Edinburgh and outside to carry many along with him. But before 1869 another line of attack had been initiated from Glasgow, and Lister was already applying principles which were to win the battle with more certainty of permanent success.
Glasgow was no more free from these troubles than other great towns; in fact it suffered more than most of them. With its rapid industrial development it had already in 1860 a population of 390,000. Its streets were narrow, its houses often insanitary. In the haste to make money its citizens had little time to think of air and open spaces. The science of town-planning was unborn. Its hospital, far from having any special advantage of position, was exposed to peculiar dangers. It lay on the edge of the old cathedral graveyard, where the victims of cholera had received promiscuous pit-burial only ten years before. The uppermost tier of a multitude of coffins reached to within a few inches of the surface. These horrors have long been swept away; but, when Lister took charge of his wards in the Infirmary, they were infected by the poisonous air generated so close at hand, and in consequence they presented a gruesome appearance. The patients came from streets which often were foul with dirt, smoke, and disease, and were admitted to gloomy airless wards, where pyaemia or gangrene were firmly established. In such an environment certain death seemed to await them.
Though his heart must have sunk within him, Lister set himself bravely to the task of fighting these grim adversaries. For two years, indeed, he was chiefly occupied with routine work and practical improvements; but he continued his speculations, and in 1861 an article on amputations which he contributed to the System of Surgery, a large work in four volumes published in London, showed that he had not lost his power of surveying questions broadly and examining them with a fresh and original insight. He was not in danger of letting his mind be swamped with details, but could put them in their place and subordinate them to principles; and his article is chiefly directed to a philosophical survey which would enable his readers to go through the same process of education which he had followed out for himself. Sir Hector Cameron, the most constant of his Glasgow disciples, once illustrated this philosophic spirit from a passage in Cicero contrasting the many scientists who 'render themselves familiar with the strange' (not realizing that it is strange or needs explanation) with the few who 'render themselves strange to the familiar'—who stand away from the phenomena to which every one has become too accustomed and examine them afresh for themselves. In Lister he recognized the peculiar gift which enabled him to rise superior to his subject, and to interpret what was to his colleagues a sealed book. In these days, among the too familiar scourges of the hospital, his work was perpetually putting questions to him; to a man whose mind was open the answer might come at any moment and from any quarter.
As a fact, already, far from his own circle and for a long while out of his ken, there was working in France the most remarkable scientist of the century, Louis Pasteur, who more than once put his scientific ability at the disposal of a stricken industry, and in his quiet laboratory revived the industrial life of a teeming population. A manufacturer who was confronted with difficulties in making beetroot-alcohol and was threatened with financial ruin, appealed for his help in 1856; and Pasteur spent years on the study of fermentation, making countless experiments to test the action of the air in the processes of putrefaction, and coming to the conclusion that the oxygen of the air was not responsible for them, as was widely believed. He went further and reached a positive result. He satisfied himself that putrefaction was set up by tiny living organisms carried in the dust of the air, and that the process was due to what we now familiarly term 'germs' or 'microbes'. The existence of these infinitesimal creatures was known already to scientists, but their importance was not grasped till Pasteur, in the years 1862 to 1864, expounded the results of his long course of studies. He himself was no expert in medicine, but his discovery was to bear wonderful fruit when it was properly applied to the science of health and disease. Lister's study of open wounds, his observation of the harm done to the tissues in them when vitality was impaired, and of the value of protective scabs when they formed, enabled him to see the way and to point it out to others. When in 1865 he first read the papers which Pasteur had been publishing, he found the principle for which he had so long been searching. With what excitement he read them, with what suddenness of conviction he accepted the message, we do not know; he has left no record of his feelings at the time: but it was the most important moment in his career, and the rest of his life was spent in applying these principles to his professional work.
With his mind thus fortified by the knowledge of the true source of the mischief, realizing that he had to assist in a battle between the deadly germs carried in the air and the living tissues trying to defend themselves, Lister returned afresh to the study of methods. He knew that he had to reckon with germs in the wound itself, if the skin was broken, with germs on the hands and instruments of the operator, and with germs on the dust in the air. He must find some defensive power which was able to kill the germs, at least in the first two instances, without exercising an irritating effect on the tissues and weakening their vitality. The relative importance of these various factors in the problem only time and experience could tell him. Carbolic acid had been discovered in 1834 and had already been tried by surgeons with varying results. At Carlisle it had been used by the town authorities to cope with the foul odour of sewage, and Lister visited the town to study its operation. In its cruder form carbolic proved only too liable to irritate a wound and was difficult to dissolve in water. Lister tried solutions of different strengths, and finally arrived at a form of carbolic acid which proved to be soluble in oil and to have the 'antiseptic' force which he desired—that is, to check the process of sepsis or putrefaction inside the wound. He also set himself to devise some 'protective' which would enable Nature to do her healing work without further interference from without. Animals have the power to form quickly a natural scab over a wound, which is impermeable and at the same time elastic. The human skin, after a slight wound, in a pure atmosphere, may heal quickly; but a serious wound may continue open for a long time, discharging 'pus' at intervals, while decomposition is slowly lowering the vitality of the patient. Lister made numerous experiments with layers of chalk and carbolic oil, with a combination of shellac and gutta-percha, with everything of which he could think, to imitate the work of nature. His inexhaustible patience stood him in good stead in all these practical details. Rivals might speak contemptuously of the 'carbolic treatment' and the 'putty method' as if he were the vender of a new quack medicine; but at the back of these details was a scientific principle, firmly grasped by one man, while all others were groping in the dark.
