JOSEPH LISTER 1827-1912

            Joseph Lister, an English surgeon, was born in 1827 at Upton, Essex. He was the found­er of antiseptic surgery. Joseph was the fourth of seven children of whom four were boys and three girls. His father was a well-known scientist. Joseph Lister was the first to discover the reasons for injection and the way to prevent it. He wrote his famous pa­per The Early Stage of Inflammation. About that time, he began work on coagulation of the blood, a subject related to the early stag­es of inflammation.

             Joseph was a strong, healthy, good-looking boy. He loved to ride his father’s horses, play cricket or go skating with his brothers and sister. He was very interested in nature and birds. Joseph loved the country all his life. In his later years, whenever, he had a difficult problem on his mind, he went for long walks to think it over.

              Like his father, Joseph became interested in science. Even at school he began to dis­sect animals. It was clear that Joseph Lister was born to be a surgeon.

              When Joseph was about twelve, he was sent to a Quaker* school.

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*Quaker — (a member) of a Christian religious group called the Society of Friends. Quakers believe in |inner light|. have no ministers or organized service, and often spend their reli­gious services (called Meetings) in silence. Quakers are known for their opposition to violence and war and are active in helping other people and in education.

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             There he began to study anatomy. While the other boys were play­ing, Joseph was drawing various parts of the human body and naming the bones.

             One day during the school holidays, when he was left alone in the house, he killed and dismembered a frog and reconstructed its skeleton.

             Anatomy interested him so that when he was fourteen he told his father that he was sure he wanted to become a surgeon. His father did all he could to give his son a good start in his career.

            When he was seventeen, Joseph Lister was sent to University College in London. At first Joseph was not at all happy. He hated London and missed the country but soon he threw himself heart and soul into his work. He worked so hard that in 1848 his health broke down, and he had to take a long rest.

            Lister’s medical training lasted for nearly eight years. In 1852, his student days were over. Professor James Syme*, then the most famous surgeon in Europe, advised him to work for a time at the important medical school in Edinburgh.

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*Syme, James (1799-1870) — Scottish surgeon.

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            In 1853, Lister went there. He only meant to stay in Edinburgh a month. Instead he stayed seven years. His work was simple: he had to assist the Pro­fessor in operations, and make notes on the cases.

            In 1856, he married Agnes Syme, the daugh­ter of Professor Syme. They lived together 37 years. Mrs Lister helped her husband with his work, taking down his lectures from dictation. This was a great help, for Joseph Lister could dictate far more fluently that he could write. He was very delightful with his work. He worked very hard. At first he did not like lecturing. He often spent most of the night composing his lectures, tear­ing up page after page and beginning again. Little by little he overcame his early nerv­ousness and became an extremely good speaker. He no longer read his lectures but spoke with help of a few notes. He soon had a class of nearly 200 students — the larg­est medical class in the country. Then he was asked to take charge of the surgical section of Glasgow’s Royal Infirmary. It was there that he carried out his revolutionary work for which he is now famous.

            To understand the great work, which Joseph Lister did, we must know the conditions in the hospitals in those early days of the 19^th century. Operating rooms were usually in separate buildings so that the other patients in the hospital could not hear the screams of the unhappy patient who was strapped to the operating table. Because of the terri­ble pain, the surgeon had to operate as quick­ly as possible. The operating tables were lit­tle better than kitchen tables. Under these tables a tub of sand was placed to catch the blood from the operation. The instruments were often not even washed.

             The surgeons were not indifferent or care­less. They had simply no understanding at all of the bad effects of dirt. They were sor­ry that their patients died so often but they did not connect this with dirt.

             Indeed nearly half the people died from blood poisoning after operations. When Lister be­gan operating at the Royal Infirmary at Glas­gow, he too lost patient from blood poisoning.

             In Lister’s times there was a woman whose name is known all over the world shows how the reasons of the effects of dirt were found. Her name was Florence Nightingale.

             Born in Florence, Italy, on May 12, 1820, she was raised mostly in Derbyshire, Eng­land and received a classical education from her father. In 1849, she went abroad to study the European hospital system, and in 1850 she began training in nursing at the Insti­tute of Saint Vincent de Paul in Alexandria, Egypt. Then she studied in Germany. In 1853, she was superintendent of the Hospi­tal for Invalid Gentlewomen in London.

             After the Crimean War* broke out in 1853, Florence Nightingale, stirred by reports of the primitive sanitation methods and inad­equate nursing facilities at the British barracks-hospital in Uskudar (now part of Istambul, Turkey), sent a letter to the British Secretary of War, volunteering her servic­es.

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*Crimean War (1853- 1856) — a war in which Russian fought against Turkey, Britain, France, and Sardinia, began because of an argument over the holy places in Palestine and ending with the fall of the Russian base in Sevastopol.

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              Unaware of her action, the Minister of War proposed that she assumed direction of all nursing operations at the war front. She went to Turkey accompanied by 38 nurs­es. Under Nightingale’s supervision, effi­cient nursing departments were established at Uskudar and later at Balaklava in the Crimea. Through her tireless efforts the mortality rate among the sick and the wounded was greatly reduced.

             At the close of the war in 1860, with a fund raised in tribute to her services, Nightin­gale founded the Nightingale School and Home for Nurses at Saint Thomas Hospital in London. The opening of this school marked the beginning of professional edu­cation in nursing.

             Nightingale’s contributions to the evolu­tion of nursing as a profession were inval­uable. Before she undertook her reforms, nurses were largely untrained personnel who considered their job a menial chore; through her efforts the status of nursery was raised to a medical profession with high standards of education and important re­sponsibilities. In 1907, she became the first woman to receive the British Order of Mer­it*.

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*Order of Merit — instituted in 1902 and limited in number to 24 men and women of eminence. It confers no precedence or knighthood.

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               She died in London in 1910 on August 13. Her works were translated in many lan­guages. Florence Nightingale’s new kind of nursing went hand in hand with Joseph Lister’s work.

               Modern surgery was not possible until doc­tors had learned the importance of cleanliness. When Lister read Pasteur’s papers, they were a revolution to him. The French scientist said that gangrene was caused not by air itself but by tiny organisms on microbes, called bacteria or germs, in the air. Not all bacteria are harmful. There are bacteria that help plants grow, living in soil and making it better for growing crops. Still other bacteria do their work by causing chemical changes. Of course, it was not the air itself that caused the inflammation and the gangrene. It was something in the air, something intro­duced into the wound from the outside. Could these tiny creatures come from other sources than the air? From the dirty hands of the surgeons? From badly washed in­struments? If so, it was the surgeon who was responsible for the death of his pa­tient. So Lister set to work to find a way of preventing these microbes from reach­ing the open wound.

                After Lister’s many experiments a visitor from the city of Carlisle told him that the city’s sewerage system had been in need of a disinfectant and carbolic acid was used and thanks to it the smell had disappeared. Lister disappeared and asked him to get him some carbolic acid.

                Soon after, a boy who had suffered a bad accident was brought into the hospital. He had broken his leg so badly that the broken bone could be seen.

                Lister ordered a bottle of carbolic acid. Then he went to work. He saturated his hands, instruments and everything that came in contact with the patient, with the disinfect­ant. He put on a white apron. The water in which he and his assistants washed their hands was mixed with acid. He cleaned the wound, set the broken bone, and then cov­ered the wound with bandage soaked in car­bolic acid. He thought that the carbolic acid would kill any germs in the wound and the bandage would keep more from falling it.

                The carbolic acid did what Lister had in­tended. It killed the germs. After four days there was no sign of fever and blood poisoning. At the end of six week the little boy was able to walk.

                The discovery of asepsis (the control of in­fection) created a new kind of surgery. Lister pioneered in these discoveries and brought about quite a new concept in the practice of medicine. But Lister wanted to find a mild­er from of antiseptic that would be less ir­ritating to the skin than carbolic acid. Af­ter many experiments he found that boracic acid was a better antiseptic.

                 Beside his work on antiseptics, Joseph Lister made many other contributions to surgery. Among them was the use of catgut ligature.

                 During Lister’s early days as a surgeon, silk ligatures were used. Their ends were left outside the wound until the surgeon could pull them out. This system was not good.

                 Lister knew that the human body could ab­sorb foreign particles. He wondered wheth­er antiseptic silk might be absorbed too.

                 In 1867, he made the first experiment. The patient was an old horse. Lister cut open the horse’s neck and tied a silk signature around an artery. He sewed up the open­ing. One stormy night many years later when Lister was in bed with the flu he learned that the horse was dying. Lister rushed to the stable and by the light of a lantern he opened up the neck of the horse. He saw what he had hoped to see: the silk had been neatly walled off by the surrounding tis­sue. Now he knew that it was no longer necessary to remove the ligatures used in­side the body.

                 To find a material stronger than silk Lister experimented for over a year. Finally he found catgut. Lister became famous all over the world. Surgeons could now do dif­ferent operations thanks to antiseptic methods. Lister had become a national and world hero. Gradually other surgeons be­gan to adopt Lister’s methods. They learned that germs in the air were not the chief danger. The big danger came from germs that might be on the hands or clothes of the surgeons or on the surgical instruments or bandages.

                 Lister won the battle against germs in the operating wards. In fact he was the first surgeon to insist on the habit of cleanliness in hospitals, and hand-in-hand with him in this work was Florence Nightingale.