“Believe me, with profound respect,
“Yours very sincerely,
“Joseph Lister.”
In Lister’s wards, the instruments, sponges and other articles used for dressings were first of all purified in a strong solution of carbolic acid. The same precautions were taken for the hands of the surgeon and of his assistants. During the whole course of each operation, a vaporizer of carbolic solution created around the wound an antiseptic atmosphere; after it was over, the wound was again washed with the carbolic solution. Special articles were used for dressing: a sort of gauze, similar to tarlatan and impregnated with a mixture of resin, paraffin and carbolic, maintained an antiseptic atmosphere around the wound. Such was—in its main lines—Lister’s method.
A medical student, M. Just Lucas-Championnière—who later on became an exponent in France of this method, and who described it in a valuable treatise published in 1876—had already in 1869, after a journey to Glasgow, stated in the Journal de médecine et de chirurgie pratique what were those first principles of defence against gangrene—“extreme and minute care in the dressing of wounds.” But his isolated voice was not heard; neither was any notice taken of a celebrated lecture given by Lister at the beginning of 1870 on the penetrating of germs into a purulent centre and on the utility of antisepsis applied to clinical practice. A few months before the war, Tyndall, the great English physicist, alluded to this lecture in an article entitled “Dusts and Diseases,” which was published by the Revue des cours scientifiques. But the heads of the profession in France had at that time absolute confidence in themselves, and nobody took any interest in the rumour of success attained by the antiseptic method. Yet, between 1867 and 1869, thirty-four of Lister’s patients out of forty had survived after amputation. It is impossible on reading of this not to feel an immense sadness at the thought of the hundreds and thousands of young men who perished in ambulances and hospitals during the fatal year, and who might have been saved by Lister’s method. In his own country, Lister had also been violently criticized. “People turned into ridicule Lister’s minute precautions in the dressing of wounds,” writes a competent judge, Dr. Auguste Reaudin, a professor at the Geneva Faculty of Medicine, “and those who lost nearly all their patients by poulticing them had nothing but sarcasms for the man who was so infinitely superior to them.” Lister, with his calm courage and smiling kindliness, let people talk, and endeavoured year by year to perfect his method, testing it constantly and improving it in detail. No one, however sceptical, whom he invited to look at his results, could preserve his scepticism in the face of such marked success.
Some of his opponents thought to attack him on another point by denying him the priority of the use of carbolic acid. Lister never claimed that priority, but his enemies took pleasure in recalling that Jules Lemaire, in 1860, had proposed the use of weak carbolic solution for the treatment of open wounds, and that the same had been prescribed by Dr. Déclat in 1861, and also by Maisonneuve, Demarquay and others. The fact that should have been proclaimed was that Lister had created a surgical method which was in itself an immense and beneficial progress; and Lister took pleasure in declaring that he owed to Pasteur the principles which had guided him.
At the time when Pasteur received the letter above quoted, which gave him deep gratification, people in France were so far from all that concerned antisepsis and asepsis, that, when he advised surgeons at the Académie de Médecine to put their instruments through a flame before using them, they did not understand what he meant, and he had to explain—
“I mean that surgical instruments should merely be put through a flame, not really heated, and for this reason: if a sound were examined with a microscope, it would be seen that its surface presents grooves where dusts are harboured, which cannot be completely removed even by the most careful cleansing. Fire entirely destroys those organic dusts; in my laboratory, where I am surrounded by dust of all kinds, I never make use of an instrument without previously putting it through a flame.”
Pasteur was ever ready to help others, giving them willing advice or information. In November, 1874, when visiting the Hôtel Dieu with Messrs. Larrey and Gosselin, he had occasion to notice that a certain cotton-wool dressing had been very badly done by a student in one of Guérin’s wards. A wound on the dirty hand of a labouring man had been bandaged with cotton wool without having been washed in any way. When the bandaging was removed in the presence of Guérin, the pus exhaled a repugnant odour, and was found to swarm with vibriones. Pasteur in a sitting of the Académie des Sciences, entered into details as to the precautions which are necessary to get rid of the germs originally present on the surface of the wound or of the cotton wool; he declared that the layers of cotton wool should be heated to a very high temperature. He also suggested the following experiment: “In order to demonstrate the evil influence of ferments and proto-organisms in the suppuration of wounds, I would make two identical wounds on the two symmetrical limbs of an animal under chloroform; on one of those wounds I would apply a cotton-wool dressing with every possible precaution; on the other, on the contrary, I would cultivate, so to speak, micro-organisms abstracted from a strange sore, and offering, more or less, a septic character.
“Finally, I should like to cut open a wound on an animal under chloroform in a very carefully selected part of the body—for the experiment would be a very delicate one—and in absolutely pure air, that is, air absolutely devoid of any kind of germs, afterwards maintaining a pure atmosphere around the wound, and having recourse to no dressing whatever. I am inclined to think that perfect healing would ensue under such conditions, for there would be nothing to hinder the work of repair and reorganization which must be accomplished on the surface of a wound if it is to heal.”
He explained in that way the advantage accruing to hygiene, in hospitals and elsewhere, from infinite precautions of cleanliness and the destroying of infectious germs. Himself a great investigator of new ideas, he intended to compel his colleagues at the Académie de Médecine to include the pathogenic share of the infinitesimally small among matters demanding the attention of medicine and surgery. The struggle was a long, unceasing and painful one. In February, 1875, his presence gave rise to a discussion on ferments, which lasted until the end of March. In the course of this discussion he recalled the experiments he had made fifteen years before, describing how—in a liquid composed of mineral elements, apart from the contact of atmospheric air and previously raised to ebullition—vibriones could be sown and subsequently seen to flourish and multiply, offering the sight of those two important phenomena: life without air, and fermentation.
“They are far behind us now,” he said; “they are now relegated to the rank of chimeras, those theories of fermentation imagined by Berzelius, Mitscherlich, and Liebig, and re-edited with an accompaniment of new hypotheses by Messrs. Pouchet, Frémy, Trécul, and Béchamp. Who would now dare to affirm that fermentations are contact phenomena, phenomena of motion, communicated by an altering albuminoid matter, or phenomena produced by semi-organized materia, transforming themselves into this or into that? All those creations of fancy fall to pieces before this simple and decisive experiment.”