lord lister
From a photograph by Messrs. Barraud
During 1866 and 1867 we see from his letters how he set himself to apply the new principle first to cases of compound fracture and then to abscesses, how closely and anxiously he watched the progress of his patients, and how slow he was to claim a victory before his confidence was assured. In July 1867, when he was just forty years old, he felt it to be his duty to communicate what he had learnt and to put his experience at the disposal of his fellow workers. He wrote then to The Lancet describing in detail eleven cases of compound fracture under his care, in which one patient had died, one had lost a limb, and the other nine had been successfully cured. This ratio of success to failure was far in advance of the average practice of the time; but, for all that, it is not surprising that he met with the common fate which rewards pioneers in new fields of study. It is true that other reforms were helping to reduce the number of fatal cases. Florence Nightingale had led the way, and much had been learnt about hospital management. It was possible to maintain that good results had been achieved by other methods, and that Lister's proofs were in no way decisive. But there was no need for critics to misapprehend the nature of his claims or to introduce the personal element and accuse him of plagiarism. Sir James Simpson revived the memory of a Frenchman, Lemaire, who had used carbolic acid and written about it in 1860, and refused to give Lister any credit for his discoveries. As a fact Lister had never heard of Lemaire or his work; and, besides, the Frenchman had never known the principles on which Lister based his work, nor did he succeed in converting others to his practice. How little the personal question need be raised between men of the highest character is shown by the relations of Darwin and Wallace, who arrived independently and almost simultaneously at their theory of the origin of species, Wallace put his notes, the fruit of many years of work, at the disposal of Darwin; and both continued to labour at the establishment of truth, each giving generous recognition to the other's part in the work.
Unmoved then by this and other attacks, Lister continued his experiments and spent the greatest pains, for years in succession, in improving the details of his treatment. It would take too long to narrate his struggles with carbolized silk and catgut in the search for the perfect ligature, which should be absorbed by the living tissues without setting up putrefaction in the wound; or his countless experiments to find a dressing which should be antiseptic without bringing any irritating substance near the vital spot. These latter finally resulted in the choice of the cyanide gauze, which with its delicate shade of heliotrope is now a familiar object in hospital and surgery. But one story is of special interest because it shows us clearly how Lister, while clinging to a principle, was ready to modify the details of treatment by the lessons which experience taught him. It was on the advice of others that he first introduced a carbolic spray in order to purify the air in the neighbourhood of an operation. At first he used a small spray worked by hand, but this was, for practical reasons, changed into a foot-spray and afterwards into one worked by steam. One objection to this was that the steam-engine was a cumbrous bit of apparatus to carry about with him to operations; and Lister all his life loved simplicity in his methods. Another was that the carbolic solution, falling on the hands of the operator, might chill them and impair his skill in handling his instruments. Lister himself suffered less in this way than most other surgeons; with some men it was a grave handicap. The spectators at a demonstration found it inconvenient, and in one instance at least we know that the patient was upset by the carbolic vapour reaching her eyes. This was no less a person than Queen Victoria, upon whom Lister was called to operate at Balmoral in 1870. About the use of this apparatus, which was an easy mark for ridicule, Lister had doubts for some time; but it was not the ridicule which killed it, but his growing conviction that it did not afford the security which was claimed for it. He was hesitating in 1881; in 1887 he abandoned the use of the spray entirely; in 1890 he expressed publicly at Berlin his regret for having advocated what had proved to be a needless complication and even a source of trouble in conducting operations. In adopting it he had for once been ready to listen to the advice of others without his usual precaution of first-hand experiments; in abandoning it he showed his contempt for merely outward consistency in practice and his willingness to admit his own mistakes.
It was at Glasgow that Lister made his initial discoveries and conducted his first operations under the new system. It was in the Glasgow Infirmary that he worked cures which roused the astonishment of his students, however incredulous the older generation might be. He had formed a school and was happy in the loyal service and in the enthusiasm of those who worked under him, and he had no desire to leave such a fruitful field of work. But when in 1869 his father-in-law, owing to ill-health, resigned his professorship, and a number of Edinburgh students addressed an appeal to Lister to become a candidate for the post, he was strongly drawn towards the city where he had married and spent such happy years. No doubt too he and his wife wished to be near Syme, who lived for fourteen months after his stroke, and to cheer his declining days. Lister was elected in August 1869 and moved to Edinburgh two months later. For a while he took a furnished house, but early in 1870 he made his home in Charlotte Square, from which he had easy access to the gardens between Princes Street and the Castle, 'a grand place' for his daily meditations, as he had it all to himself before breakfast. Altogether, Edinburgh was a pleasant change to him, and refreshing; and the one man who was likely to stir controversy, Sir James Simpson, died six months after Lister's arrival. Among his fellow professors were men eminent in many lines, perhaps the most striking figures being old Sir Robert Christison of the medical faculty, Geikie the geologist, and Blackie the classical scholar. The hospital was still run on old-fashioned lines; but the staff were devoted to their work, from the head nurse, Mrs. Porter, a great 'character' whose portrait has been sketched in verse by Henley,[47] to the youngest student; and they were ready to co-operate heartily with the new chief. The hours of work suited Lister better than those at Glasgow, where he had begun with an early morning visit to the Infirmary and had to find time for a daily lecture. Here he limited himself to two lectures a week, visited the hospital at midday, and was able to devote a large amount of time to bacteriological study, which was his chief interest at this time.
He stayed in Edinburgh eight years, and it was during his time here that he saw the interest of all Europe in surgical questions quickened by the Franco-German war, and had to realize how incomplete as yet was his victory over the forces of destruction. Some enterprising British and American doctors, who volunteered for field-service, came to him for advice, and he wrote a series of short instructions for their guidance; but he soon learnt how difficult it was to carry out his methods in the field, where appliances were inadequate and where wounds often got a long start before treatment could be applied. The French statistics, compiled after the war, are appalling to read: 90 out of 100 amputations proved fatal, and the total number of deaths in hospital worked out at over 10,000. The Germans were in advance of the French in the cleanliness of their methods, and some of their doctors were already beginning to accept the antiseptic theory; but it was not till 1872 that this principle can be said to have won the day. The hospitals on both sides were left with a ghastly heritage of pyaemia and other diseases, raging almost unchecked in their wards; but, in the two years after the war, two of the most famous professors in German Universities[48] had by antiseptic methods obtained such striking results among their patients that the superiority of the treatment was evident; and both of them generously gave full credit to Lister as their teacher. When he made a long tour on the Continent in 1875, finishing up with visits to the chief medical schools in Germany, these men were foremost in greeting him, and he enjoyed a conspicuous triumph also at Leipzig. Sir Rickman Godlee, commenting on the indifference of his countrymen, says that Lister's teaching was by them 'accepted as a novelty, when it came back to England, refurbished from Germany'. But this was not till after he had left Edinburgh, to carry the torch of learning to the south.
In Edinburgh his colleagues, with all their opportunities for learning at first hand, seemed strangely indifferent to Lister's presence in their midst, even when foreigners began to make pilgrimages to the central shrine of antiseptics. The real encouragement which he got came, as before, from his pupils, who thronged his lecture-room to the number of three or four hundred, with sustained enthusiasm. In some ways it is difficult to account for the popularity of his lectures. He made no elaborate preparations, but was content to devote a quiet half-hour to thinking out the subject in his arm-chair. After this he needed no notes, having his ideas and the development of his thought so firmly in his grasp that he could follow it out clearly and could hold the attention of his audience. His voice, though musical, was not of great power. He was often impeded by a slight stammer, especially at the end of a session. He was not naturally an eloquent man, and attempted no flights of rhetoric. But it seems impossible to deny the possession of special ability to a man who consistently drew such large audiences throughout a long career; and if it was the matter rather than the manner which wove the spell, surely that is just the kind of good speaking which Scotsmen and Englishmen have always preferred.
And so it needed an even greater effort than at Glasgow for Lister to strike his tent and adventure himself on new ground. It is true that London was his early home; London could give him wider fame and enable him to make a larger income by private practice; yet it is very doubtful whether these motives combined could have induced him to migrate again, now that he had reached the age of fifty. But he was a man with a mission. Some of his few converts in London held that only his presence there could shake the prevailing apathy, and he himself felt that he must make the effort in the interests of science.
The professorial chair to which he was invited in 1877 was at King's College, which was relatively a small institution; its hospital was not up to the Edinburgh standard; the classes which attended his lectures were small. Owing to an unfortunate incident he was handicapped at the start. When receiving a parting address from 700 of his Edinburgh students he made an informal speech in the course of which he compared the conditions of surgical teaching then prevailing at Edinburgh and London, in terms which were not flattering to the southern metropolis. Some comparison was natural in the circumstances; Lister was not speaking for publication and had no idea that a reporter was present. But his remarks appeared in print, with the result that might be expected. The sting of the criticism lay in its truth, and many London surgeons were only too ready to resent anything which might be said by the new professor. When he had been living some time in London, Lister succeeded in allaying the ill feeling which resulted; but at first, even in his own hospital, he was met by coldness and opposition in his attempt to introduce new methods. In fact, had he not laid down definite conditions in accepting the post, he could never have made his way; but he had stipulated for bringing with him some of the men whom he had trained, and he was accompanied by four Edinburgh surgeons, the foremost of whom were John Stewart, a Canadian, and Watson Cheyne, the famous operator of the next generation. Even so he found his orders set at naught and his work hampered by a temper which he had never known elsewhere. In some cases the sisters entrenched themselves behind the Secretary's rules and refused to comply, not only with the requests of the new staff, but even with the dictates of common sense and humanity. Another trouble arose over the system of London examinations which tempted the students to reproduce faithfully the views of others and discouraged men from giving time to independent research. Lister's method of lecturing was designed to foster the spirit of inquiry, and he would not deign to fill his lecture-room by any species of 'cramming'. Never did his patience, his hopefulness, and his interest in the cause have to submit to greater trials; but the day of victory was at hand.
The most visible sign of it was at the International Medical Congress held at Amsterdam in 1879 and attended by representatives of the great European nations. One sitting was devoted to the antiseptic system; and Lister, after delivering an address, received an ovation so marked that none of his fellow-countrymen could fail to see the esteem in which he was held abroad. Even in London many of his rivals had by now been converted. The most distinguished of them, Sir James Paget, openly expressed remorse for his reluctance to accept the antiseptic principle earlier, and compared his own record of failures with the successes attained by his colleague at St. Bartholomew's Thomas Smith, the one eminent London surgeon who had given Listerism a thorough trial. Other triumphs followed, such as the visits in 1889 to Oxford and Cambridge to receive Honorary Degrees, the offer of a baronetcy in 1883, and the conferring on him in 1885 of the Prussian 'Ordre pour le merite'.[49] But a chronicle of such external matters is wearisome in itself; and before the climax was reached, the current of opinion was, by a strange turn of fortune, already setting in another direction.