New volumes of the Encyclopædia Britannica > Volume 30, K-MOR

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LISTER
things at any rate was changed. The pain of the opera¬
tion itself no longer counted, and the surgeon was enabled
not only to be as cautious and sedulous as dexterous, but
also to venture upon long, profound, and intricate opera¬
tions which before had been out of the question. Yet
unhappily this new enfranchisement seemed to be but
an ironical liberty of Nature, who with the other hand
took away what she had given. Direct healing of surgical
wounds (“by first intention”), far from being the rule,
was a piece of luck too rare to enter into the calculations
of the operator ; while of the graver surgical undertakings,
however successful mechanically, the mortality by sepsis
was ghastly. At all times suppuration, phagedeena, and
septic poisonings of the system carried away even the most
promising patients and followed even trifling operations.
Often, too, these diseases rose to the height of epidemic
pestilences, so that patients,
however extreme their need,
dreaded the very name of
hospital, and the most skilful
surgeons distrusted their own
craft. New hospitals or new
wards were built, yet after
a very short time the new
became as pestiferous as
the old; and even scrupu¬
lous care in ventilation and
housemaids’ cleanliness failed
to prevent the devastation.
Surgery had enlarged its
freedom, but only to find
the weight of its new re¬
sponsibilities more than it
could bear.
When Lister was ap¬
pointed to the chair of
.surgery in Glasgow the in¬
firmary of that city was a
hotbed of septic disease; so
much so that his hospital
visits evidently distressed
him greatly. Windows were
widely opened, piles of clean
towels were supplied, but
still the pestilence stalked
through the wards. The
building stands to-day as it
stood then, with no substantial alteration; but by the
genius of Lister its surgical wards are now as free from
septic accidents as the most modern hospital in the land.
James Simpson, early in the ’sixties, pathetically de¬
nounced the awful mortality of operations in hospitals,
and indeed uttered desperate protests against the hospital
system itself; yet, not long afterwards, Lister came to prove
that it was not in the hospital that the causes of that
mortality lay hidden, but in the operator himself, his tools,
and his assistants. Happily this beneficent discovery
was made in time to preserve the inestimable boon of
the hospital system from the counsels of despair. When
Lister took up the task speculation was on the wrong
tack; the oxygen of the air was then supposed to be the
chief cause of the dissolution of the tissues, and to pre¬
vent access of air was impossible. For instance, a simple
fracture, as of a bone of the leg, would do perfectly well,
while in the very next bed a compound fracture—one,
that is, where the skin is lacerated, and access to the
seat of injury opened out—would go disastrously wrong.
If the limb were amputated, a large proportion of such
cases of amputation succumbed to septic poisoning—the
fell and occult foe.
Lord Lister.
(From a photograph by Elliott and Fry, London.)
On graduation as bachelor of medicine, Lister went
to Edinburgh, where he soon afterwards became house-
surgeon to Mr Syme ; and he was much impressed by the
skill and judgment of this great surgeon, and also by the
superiority of his method of dressing recent wounds with
dry lint, as compared with the “ water dressing ” in use
at University College. Yet under these more favourable
conditions the amelioration was only one of degree; in
most wounds indeed “ union by first intention ” was
rendered impossible by the presence of the silk ligatures
employed for arresting bleeding, for these could come
away only by a processs of suppuration. On the expiry
of his house-surgeoncy in Edinburgh, Lister started in
that city an extra-academical course of lectures on surgery;
and in preparation for these he entered on a series of in¬
vestigations into inflammation and allied subjects. These
researches, which were de¬
tailed fully in three papers
in Phil. Trans., 1859, and in
his Croonian lecture to the
Royal Society in 1863, testi¬
fied to an earnestness of pur¬
pose, a persevering accuracy
of observation and experi¬
ment, and an insight of
scientific conception which
show that if Lister had never
developed the aseptic method
of surgery, he would have
taken a very high place in
pathology. In any case his
earlier work was an indis¬
pensable preliminary to his
later labours. In his speech
in Paris at the Thirteenth
International Congress of
Medicine in 1900, Lord
Lister said that he had done
no more than seize upon
Pasteur’s discoveries and
apply them to surgery. But
though Lister saw the vast
importance of the discoveries
of Pasteur, he saw it because
he was watching on the
heights; and he was watch¬
ing there alone. From Pas¬
teur Lister derived no doubt two fruitful ideas: first,
that decomposition in organic substances is due to living
“germs”; and, secondly, that these lowly and minute
forms of vegetable life spring always, like higher organ¬
isms, from parents like themselves, and cannot arise de
novo in the animal body. After his appointment to the
Glasgow chair in 1860, Lister had continued his researches
on inflammation; and he had long been led to suspect
that decomposition of the blood in the wound was the
main cause of suppuration. The two great theories estab¬
lished by Pasteur seemed to Lister to open out the
possibility of what had before appeared hopeless—namely,
the prevention of putrefaction in the wound, and conse¬
quently the forestalling of suppuration. To exclude the
oxygen of the air from wounds was impossible, but it
might be practicable to protect them from microbes.
The first attempt to realize this idea was made upon
compound fractures; and the means first employed was
carbolic acid, the remarkable efficacy of which in deodoriz¬
ing sewage made Lister regard it as a very powerful
germicide. It was applied to the wound undiluted, so
as to form with the blood a dense crust, the surface of
which was painted daily with the acid till all danger had