Joseph Lister: Father of Modern Surgery

A broken leg today is very painful. It requires medical treatment, and can be of great inconvenience to the patient during the recuperation stage. Even if the broken bone has pierced the surface of the skin, the patient has every expectation of returning to a normal healthy lifestyle.

Just 150 years ago this was not the case—the leg probably would have been amputated, and in about half of such cases the patient subsequently would have died of infection. The man whose work virtually put an end to this tragic waste of human life was Joseph Lister.

Lister’s early life

Joseph Lister was born in Upton, Essex, England, on April 5, 1827. He was the second of three children born to Joseph Jackson Lister, a very successful wine merchant and amateur scientist. Joseph Jackson Lister’s design of a microscope lens which did not distort colours opened the way for the microscope to be used as a serious scientific tool. This contribution to science resulted in Joseph Jackson Lister’s being made a Fellow of the Royal Society—the prestigious British association of experimental scientists.

The Listers were Quakers who led a quiet, simple life. Young Joseph attended Quaker schools in Hertfordshire and London, where science subjects were emphasized. Following matriculation, he obtained a Bachelor of Arts degree at the University of London in 1847. Shortly after this he contracted smallpox. When he had fully recovered, he returned to the University of London as a medical student, qualifying as a doctor in 1850. Lister obtained Bachelor’s degrees in Medicine and Surgery, and in the process won two university gold medals for his outstanding marks. Further study saw Lister easily pass the examination to become a Fellow of the Royal College of Surgeons (FRCS) in 1852.

Overcoming hurdles

Modern surgery as we know it today was not able to develop until three great hurdles had been overcome. These were the control of bleeding, the control of pain, and the control of infection. In 1552, a leading French doctor, Ambroise Pare, developed and systematized the idea of tying off the ends of broken or cut blood vessels with threads called ligatures in order to minimize bleeding. The control of pain through anaesthesia was just being introduced during the time when Lister was a university student. Before this, surgery had involved agony for the struggling patient, which in turn meant that doctors had to operate as quickly as possible.

The introduction of anaesthetics opened up a new era in surgery, as doctors were now able to take the time necessary to improve their techniques. The third major hurdle, the control of infection, remained unconquered when Lister began working as a surgeon.

Recognition of research

In 1853, Lister went to Edinburgh, Scotland, to spend four weeks with Professor James Syme, who was considered to be the greatest teacher of surgery at that time. Lister soon decided to stay in Edinburgh as Syme’s assistant. Three years later, Lister married Syme’s daughter Agnes and joined her as a member of the Episcopal church. He remained a faithful member of this church for the remainder of his life. Throughout the Listers’ long and happy, but childless, marriage, Agnes was of great assistance to her husband, helping with experiments and writing up his notes.

Lister had decided not just to practise medicine, but also to conduct research to improve medical knowledge.

While still a student, Lister had decided not just to practise medicine, but also to conduct research to improve medical knowledge. His early investigations explored the action of muscles in the skin and the eye, the mechanism involved in the coagulation of blood, and the role played by blood vessels in the early stages of infection. Lister's research required frequent use of a microscope—a tool very familiar to him because of his father's involvement with it. Lister’s research required considerable sacrifice and dedication, as it was undertaken at night after he had completed a full working-day in the hospital wards. Recognition of Lister’s early research came in 1860, when he was made a Fellow of the Royal Society, the same honour that had been bestoyed upon his father.

In the Edinburgh Hospital where Lister worked, almost half of the surgery patients died from infection. In some hospitals in Europe, as many as 80 per cent died. While surgeons regretted this high death rate, they trained themselves to accept this unpleasant aspect of their work. After all, they thought, nothing could be done about these infections, because they arose spontaneously inside the wound. Lister however, was not convinced of the inevitability of infection (which was also known as sepsis). He began to search for a way of preventing infection—that is, an antisepsis method.

Preventing infection

Lister’s first clue as to the cause of infection came from comparing patients who had simple fractures with those who had compound fractures. Simple fractures do not involve an external wound. These patients had their bones set and placed in a cast, and they recovered. Compound fractures are those where the broken bone pierces the skin and is exposed to the air. More than half of these patients died. Lister reasoned that somehow the infection must enter the wound from the outside. But how exactly did this occur? And what could be done to prevent it?

Lister began washing his hands before operating, and wearing clean clothes. (Others such as Florence Nightingale, the pioneer of modern nursing, had already found that increased cleanliness reduced the death rate from infection among hospital patients. However, these ideas had not yet gained widespread acceptance because the reason behind their success was not understood.) Even though Lister’s procedures were scoffed at by some of his colleagues, who considered it a status symbol to be covered in blood from previous operations, his talent was becoming recognized. In 1860 he became Professor of Surgery at Glasgow. There, a friend lent him some research papers by the outstanding French chemist, Louis Pasteur. (Like Lister, Pasteur was a committed Christian.)

As the son of a wine merchant, Lister was all too familiar with the problem of wine going bad because of faulty fermentation. Pasteur had shown that the problem was caused by germs which entered from the air, and that organisms did not come to life spontaneously from non-living matter within the wine. Pasteur had demonstrated that life arose from life. His experiments gave no support to the evolutionary idea that the first life arose from non-living matter—a belief still held today by evolutionists. Unlike the evolutionists, whose thinking was held back by their attachment to the idea of spontaneous generation, Lister immediately recognized the truth and usefulness of Pasteur’s work. If infection arose spontaneously within a wound, it would be virtually impossible to eliminate it. However, if germs entering from the air outside the wound caused infection (in the same way that the wine became contaminated), then those germs could be killed and infection prevented.

Above: An operation in progress in the late 1800s. The man on the right is using a version of Lister’s carbolic spray.

Pasteur had used heat and filters to eliminate the germs in the wine, but these techniques were not suitable for use with human flesh. Instead, Lister needed to find a suitable chemical to kill the germs. He learned that carbolic acid was being used as an effective disinfectant in sewers and could safely be used on human flesh. Beginning in 1865, Lister used carbolic acid to wash his hands, his instruments, and the bandages used in the operation. Lister also sprayed the air with carbolic acid to kill airborne germs. After more than a year of using and refining these techniques, Lister had sufficient data to show that his methods were a success. He published his findings in the medical journal, The Lancet, in 1867.

Lister was always eager to acknowledge Louis Pasteur’s invaluable contribution. In a letter to Pasteur in February 1874, Lister gave him ‘thanks for having, by your brilliant researches, proved to me the truth of the germ theory. You furnished me with the principle upon which alone the antiseptic system can be carried out.’1

Slow acceptance

Two years after publishing his findings, Lister returned to Edinburgh to become Professor of Clinical Surgery—the position formerly held by his eminent father-in-law for more than three decades. Lister introduced his antisepsis procedures in Edinburgh and again met with dramatic success. However, widespread acceptance of Lister’s procedures was rather slow, as is often the case with revolutionary new ideas. Some busy doctors were unwilling to take the time to even consider new ideas. Some found it difficult to believe in germs—living organisms that wrought havoc but were too small to see. Others tried Lister’s procedures, but did so incorrectly and therefore failed to obtain the desired result. (Part of the reason for this was the complexity of Lister’s procedures and the constant modifications he made to his system in order to improve them.) Also, Lister’s method added to the expense involved in dressing wounds.

Lister was neither angered nor discouraged by the controversy that raged about his work. Instead, ‘Lister went on his gentle, unconcerned way saving his patients and trying to cheer them while doing so’.2 His compassionate personal involvement with his patients was quite a contrast to the arrogance of those surgeons who believed that such involvement would ‘somehow lessen the holy awe and respect in which patients should hold their doctors’.3

Over the next 12 years, Lister’s methods gradually gained acceptance. Doctors from Denmark and Germany were the first to implement Lister’s antiseptic principle, and they met with stunning success. (For example, in Munich the death rate from infection after surgery dropped from 80 per cent to almost zero.) By 1875, Lister was receiving international acclaim in Europe. However, the majority of English doctors still misunderstood Lister’s work and therefore failed to accept its usefulness. It was not until Lister was appointed Professor of Surgery at King’s College Hospital in London in 1877 that he began to win over the English doctors. By 1879, Lister’s principle of antiseptic surgery had gained almost universal acceptance.

New techniques

Lister went on to develop new surgical techniques by applying his antiseptic principle. He showed that suitably sterilized materials could be left inside the patient. In 1877, he tied broken bones together with sterilized silver wire which was left inside the patient. ‘Anyone trying to wire the broken pieces together without the antiseptic technique would be faced with an infected knee and hospital gangrene.’4 In 1880, he introduced the use of sterilized catgut for internal stitches, as this would subsequently dissolve. (Previously, silk thread used in internal stitching was left hanging out of the wound and was pulled out later, often causing further damage.) Lister also introduced the use of rubber drainage tubes after first using one on Queen Victoria. (For many years he had been surgeon to the Queen.)

In 1883, Queen Victoria honoured Lister by making him Sir Joseph Lister. In 1897, he was given the title Lord Lister of Lyme Regis. He was first to be made a British peer for services to medicine. In 1902, he was given the Order of Merit, and made a Privy Councillor.

In his later years, Lister was given many prestigious positions by the scientific community in recognition of his great contribution to medicine. These included Vice-President of the Royal College of Surgeons, President of the Royal Society, and President of the British Association for the Advancement of Science. In 1891, Lister had helped to establish the British Institute of Preventative Medicine. In 1903, this was renamed the Lister Institute in his honour.

Conclusion

Lister died on February 10, 1912, at Walmer, Kent, England. He had retired in 1893 after a long and outstanding career. Although the materials and procedures used have changed over the years, the antiseptic principle itself remains today as the cornerstone of modern surgery. The importance of Lister’s antiseptic principle is emphasized by eminent creation scientist, Dr. Henry Morris, who says, ‘This development is probably second only to Pasteur’s contribution to the saving of human lives’.5

Lister was a committed Christian. He wrote: ‘I am a believer in the fundamental doctrines of Christianity’.6 Lister’s character readily showed the outworking of his faith. The World Book Encyclopedia says that ‘Throughout his life, he remained a gentle, shy, unassuming man, firm in his purpose because he humbly believed himself to be directed by God.’7