1827-1912
1827. born at west ham, april 5.
1844-52. university college, london.
1851. acting house surgeon under erichsen.
1852. first research work published.
1853. goes to edinburgh. house surgeon under syme.
1855. assistant surgeon and lecturer at edinburgh infirmary.
1856. marries agnes syme.
1860. appointed professor of clinical surgery at glasgow.
1865. makes acquaintance with pasteur’s work.
1866-7. antiseptic treatment of compound fractures and abscesses.
1867. papers on antiseptic method in the lancet.
1869. appointed professor of surgery at edinburgh.
1872-5. conversion of leading scientists in germany to antisepticism.
1875. lister’s triumphal reception in germany.
1877. accepts professorship at king’s college, london.
1879. medical congress at amsterdam. acceptance of lister’s methods by paget and others in london.
1882. von bergmann develops asepticism in berlin.
1883. lister created a baronet.
1891. british institute of preventive medicine incorporated.
1892. lister attends pasteur celebration in paris.
1893. death of lady lister.
1895-1900. president of royal society.
1897. created a peer.
1902. order of merit.
1907. freedom of city of london: last public appearance.
1912. dies at walmer, february 10.
joseph lister
surgeon
in a corner of the north transept of westminster abbey, almost lost among the colossal statues of our prime ministers, our judges, and our soldiers, will be found a small group of memorials preserving the illustrious names of darwin, lister, stokes, adams, and watt, and reminding us of the great place which science has taken in the progress of the last century. watt, thanks partly to his successors, may be said to have changed the face of this earth more than any other inhabitant of our isles; but he is of the eighteenth century, and between those who developed his inventions it is not easy to choose a single representative of the age. stokes and adams command the admiration of all students of mathematics who can appreciate their genius, but their work makes little appeal to the average man. in darwin’s case no one would dispute his claim to represent worthily the scientists of the age, and his life is a noble object for study, single-hearted as he was in his devotion to truth, persistent as were his efforts in the face of prolonged ill-health. no better instance could be found to show that the highest intellectual genius may be found united with the most endearing qualities of character. kindly and genial in his home, warmly attached to his friends, devoid of all jealousy of his fellow scientists, he lived to see his name honoured throughout the civilized world; and many who are incapable of appreciating his originality of mind can find an inspiring example in the record of his life. there is no need to make comparisons either of fame, of mental power, or of character; but the choice of lister may be justified by the fact that his science, the science of health and disease, is one of absorbing interest to all men, and that with his career is bound up the history of a movement fraught with grave issues of life and death from which few families have been exempt.
about these issues bitter controversies have raged; but it is to the lesser men that the bitterness is due. by his family traditions, as well as by his natural disposition, lister was a man of peace; and though he left the society of friends at the time of his marriage, he retained a respect for their views which accorded well with his own nature. when he had to speak or write on behalf of what he believed to be the truth, it was from no motive of self-assertion or combativeness. he had the calm contemplative mind of the student, whereas bright, the quaker tribune, the champion of repeal, had all the fervour of the man of action. lister’s family had been quakers since the beginning of the eighteenth century; and at this time too they moved from yorkshire to london, where his grandfather and father were engaged in business as wine merchants. but joseph jackson lister, who married in 1818, and became in 1827 the father of the famous surgeon, was much more than a merchant. he had taught himself the science of optics, had made improvements in the microscope, and had won his way within the sacred portals of the royal society. letters have been preserved which show us how keen his interest in science always remained, and with what full appreciation he entered into the researches which his son was making as professor at glasgow in the middle of the century. a father like this was not likely to grudge money on the boy’s education; but for the friends many avenues to knowledge were still closed, including the universities of oxford and cambridge. he had to be content to go successively to quaker schools at hitchin and tottenham, and from the latter to proceed, at the age of seventeen, to university college, london, which was non-sectarian. there the teaching was good, the atmosphere favourable to industry, and lister was not conscious of hardship in missing the delights of youth that fell to his more fortunate contemporaries.
his father lived in a comfortable house at upton, some six miles east of london bridge, in a district now completely swamped by the growth of the vast borough of west ham. he kept up close relations with other quaker families living in the neighbourhood, especially the gurneys of plashets. in their circle the most striking figure was elizabeth fry, who from 1813 to her death in 1843 devoted herself unsparingly to the cause of prison reform. from his home the father continued to exercise a strong influence over his son, who was industrious and serious beyond his years.
from his father lister learned as a boy to delight in the use of the microscope. he learned also to use his own power of observation, and to make hand and eye work together to minister to his studies. the power of drawing, which the future surgeon thus early developed, stood him in good stead later in life; and it is interesting to contrast his enjoyment of it with the laments made by his great contemporary darwin, who felt keenly what he lost through his inability to use a pencil and to preserve the record of what he saw in nature or in the laboratory. lister’s school-days were over when he was seventeen years old and there is nothing remarkable to tell of them; but his period at university college was unusually prolonged. he was a student there for seven years and continued an eighth year, after he had taken his degree, as acting house surgeon. in 1848, half-way through his time, a physical breakdown was brought on by overwork, just as he was finishing his general studies; but a long holiday enabled him to recover his strength, and before the end of the year he had begun the course of medical studies which was to be his life-work.
at school his record had been good but not brilliant, nor did he come quickly to the front in london. his mind was not of the sort which can be forced to produce untimely fruit in the hot-house of examinations. but his education was both extensive and thorough; it formed an excellent general training for the mind and a good basis for the special studies in which he was later to distinguish himself. he had been at university college for two years before he gained his first medal; but by 1850 he had made his name as the best man of his year, capable of upholding the credit of his college against any rival in the metropolis. among his fellow students the best known in later years was sir henry thompson, whose portrait by millais hangs in our national gallery. among his professors one stands out pre-eminent, alike for his character and for his influence on lister’s life. this was william sharpey, professor of physiology, an original man with a keen eye for originality in others. in days when most english professors were content with a narrow empirical training, he had trudged with his knapsack over half europe in quest of knowledge, had studied in france, switzerland, italy, and austria, and had made himself acquainted at first hand with the best that was taught in their schools. he was a first-rate lecturer, clear and simple, and took much pains to get to know his pupils. when lister had held for a short time the post of acting house surgeon at university college hospital, and needed to make definite plans for his career, it was sharpey who advised him to go north for a while and attend some classes in edinburgh before deciding on his course. thus it was sharpey who introduced him to scotland and to syme.
before we speak of the latter, a few words must be given to the year 1851, when lister completed his studentship and became for a time an active member of the hospital staff. this year was important as introducing him to the practice of his art under the direction of erichsen, an anglo-dane and one of the foremost surgeons in london. it also led to a change in his way of living, to his being thrown into closer relations with men of his own age, and to his taking a more lively part in social gatherings. what we hear of the essays that he wrote at school, what we can read of his early letters, all harmonizes with our conception of a quaker upbringing. there is a staid primness about him, which contrasts strangely with the pictures of medical students presented to us in the pages of dickens. capable though he was of enjoying a holiday, or of expanding among congenial associates, lister was not quick to make friends. he was apt to keep too much to himself; and he seems to have inspired respect and even a certain awe among men of his own age. in his youth men noticed the same grave mien, steadfast eyes, and lofty intellectual forehead which are conspicuous in his later portraits. he was steady in conduct, serious in manner, precise in his way of expressing himself; and while these qualities helped him in the mental application which was so necessary if he was to profit by his student days, he needed a little shaking up in order to adapt himself to the ways of other men in the sphere of active life. this was given him by the constant activities of the hospital, and by the demands which the various societies made upon him; but he did not allow them to interfere with his own researches, for which he could find time when others were overwhelmed by the routine of their daily tasks.
his first bit of original research is of special interest because it connects him with his father’s work. he made special observations with the microscope of the muscular tissue of the iris of the eye, illustrated his paper by delicate drawings of his own, and published it in the leading microscopical journal. this and a subsequent paper on the phenomena of ‘goose-skin’ attracted some attention among physiologists at home and abroad, and brought him into friendly relations with a german professor of world-wide reputation. they also gave great satisfaction to his father and to his favourite teacher sharpey.
but lister’s development henceforth was to take place on scottish ground, and his visit to edinburgh in 1853 shaped the whole course of his career. james syme, under whose influence he thus came, was the most original and brilliant surgeon then living in the british isles, perhaps in all europe. his merits as a lecturer were somewhat overshadowed by his extraordinary skill as an operator; but he was a remarkable man in all ways, and the fact that lister was admitted, first to his lecture-room and operating theatre, and then to his home, was without doubt the happiest accident in his life.
the atmosphere of edinburgh with its large enthusiastic classes in the hospitals, its cultivated and intellectual society outside, supplied just what was wanted to foster the genius of a young man on the threshold of his career. in london, centres of culture were too widely diffused, indifference and apathy too prevalent, conservatism in principles and methods too strongly entrenched. in his new home in the north lister could watch the boldest operator in his own profession, and could daily meet men scarcely less distinguished in other sciences, and as a visitor to syme’s house he was from time to time thrown among able men following widely different lines in life. above all, here he met one who was peculiarly qualified to be his helper; and three years later, at the age of twenty-nine, he was married to agnes syme, the daughter of his chief, to whom he had been attracted, as can be seen from the letters which passed between edinburgh and upton, soon after his arrival in the north. before this event, he had already made his mark as resident house surgeon, as assistant operator to syme, and also as an independent lecturer under the liberal system which gave an opening to all who could establish by merit a claim to be heard. he had also begun those researches into the early stages of inflammation which, ten years later, were to bear such wonderful fruit. it was a full and busy life, and the distraction of courtship must have made it impossible for him at times to meet all demands; but after 1856 his mind was set at rest and his strength doubled by the sympathy which his wife showed in his work, and by the help which she was able to render him in writing to his dictation.
for their honeymoon they took a long journey on the continent in the summer of 1856; but half, even of this rare holiday, was given to science, and, after some weeks’ enjoyment of the beauties of italy, husband and wife made the tour of german universities, as he was desirous to see something, if possible, of the leading surgeons and the newest methods. vienna, dresden, berlin, munich, frankfort, heidelberg, and stuttgart were all included in the tour. they were well received, and at vienna the most eminent professor of pathology in the university gave more than three hours of his time to showing his museum to lister, and also invited the young couple to dine at his house. though he had not yet made a name for himself, lister’s earnestness and intelligence always made a favourable impression; and as he had taken pains with foreign languages in his youth, he was able, now and later in life, to address french and german friends, and even public meetings, in their native tongue. he came back to find work waiting for him which would tax his energies to the full. in october 1856 he was elected assistant surgeon to the infirmary, and now, in addition to lecturing, he had to conduct public operations himself, whereas he had hitherto only acted as syme’s assistant. this was at first a severe trial for his nerves. that it affected him differently from most experienced surgeons is shown by the fact that he used always, all his life, to perspire freely when starting to operate; but he learnt to overcome this nervousness by concentrating his attention on his work. he was not a man who had religious phrases on his lips; but in letters to his family, quoted by sir rickman godlee, he gives us the secret of his confidence and his power. ‘yesterday’, he says in a letter written to his father on february 26, ‘i made my début at the hospital in operating before the students. i felt very nervous before beginning; but when i had got fairly to work, this feeling went off entirely, and i performed both operations with entire comfort.’ a week later, in a letter to his sister, he returns to the subject. ‘the theatre was again well filled; and though i again felt a good deal before the operation, yet i lost all consciousness of the presence of the spectators during its performance, and did it exactly as if no one had been looking on. just before the operation began i recollected that there was only one spectator whom it was important to consider, one present alike in the operating theatre and in the private room; and this consideration gave me increased firmness.’ interest in the work for its own sake, forgetfulness of himself, these were to be the key-notes of his life-work.
as yet, to a superficial observer, there were not many signs of a brilliant career ahead of him. his private practice was small and did not grow extensively for many years. the attendance at his earlier course of lectures was discouragingly meagre. this would have been more discouraging still, had not his dressers, from personal affection for him, made a point of attending regularly to swell the number of the class. indeed, in view of the exacting demands made on him by the hospital, lister might have been content to follow the ordinary routine of his profession. with his wife at his side and friends close at hand, he had every chance of living a useful and happy life. but he still found time to conduct experiments and to think for himself. his researches were continued along the line which he had opened up in 1855, and in 1858 he appeared before an edinburgh surgical society to read a paper on spontaneous gangrene.
this gave mrs. lister an opportunity to show her value. all his life lister was prone to unpunctuality and to being late with preparations for his addresses, not because he was indifferent to the convenience of others or careless about the quality of his teaching, but because he became so engrossed in the work of the moment that he could not tear himself away from it so long as any improvement seemed possible. this same quality made him slow over his hospital rounds and often over operations, with the result that his own meal-times were most irregular and his assistants often had trouble to stay the pangs of hunger. this handicapped him in private practice and in some measure as a lecturer. he gave plenty of thought to his subjects, but rarely began to put thoughts in writing sufficiently in advance of his engagement. when he was in time with his written matter the credit was chiefly due to his wife. on the occasion of this paper she wrote for seven hours one day and eight hours the next, and her heroic industry saved the situation.
towards the end of 1859 lister decided to be a candidate for the surgical professorship at glasgow, which appointment was in the gift of the crown; and in spite of some intrigues to secure the patronage for a local man, the post was offered by the home secretary, sir george lewis, to the young edinburgh surgeon. syme’s opinion and influence no doubt counted for much. lister’s appointment dated from january 1860, but it was not till a year and a half later that his position in glasgow was assured by his being elected surgeon to the royal infirmary. before this he could preach his principles in the lecture-room, but he had little influence on the practice of his students and colleagues. thanks to the reputation which he brought from edinburgh, his first lecture drew a full room, and his class grew year by year till it reached the unprecedented figure of 182, and each year the enthusiasm seemed to rise. but in the hospital he had an uphill task, as any one will know who has studied the history of these institutions in the first half of the century.
to-day the modern hospital is an object of general admiration, with its high standard of cleanliness and efficiency; and few of us would have any hesitation if a doctor advised us to go into hospital for an operation. seventy or a hundred years ago the case was very different; and when we read the statistics of the early nineteenth century, gathered by the surgeons who had known its horrors, it is hard to believe that we are not back among the worst abuses of the middle ages. such terrible scourges as pyaemia and hospital gangrene were rife in all of them. in the chief hospital of paris, which for centuries claimed pre-eminence for its medical faculty, the latter disease raged for 200 years without intermission: 25 per cent. of those entering its doors were found to have died, and the mortality after certain operations was more than double this figure. erichsen, who published in 1874 the statistics of deaths after operations, quoted 25 per cent. in london as satisfactory, and referred to the 60 per cent. of paris as not surprising. in military practice the number of deaths might reach the appalling figure of 80 or 90 per cent. what was so tragic about this situation was that it was precisely hospitals, built to be the safeguard of the community, which were the most dangerous places in the case of wounds and amputations. in 1869 sir james simpson, the famous discoverer of chloroform, collected statistics of amputations. he took over 2,000 cases treated in hospitals, and the same number treated outside. in the former 855 patients (nearly 43 per cent.) died, as it seemed, from the effects of the operation; in the latter only 266 cases (over 13 per cent.) ended fatally. he went so far as to condemn altogether the system of big hospitals; and under his influence a movement began for breaking them up and substituting a system of small huts, which, whether tending to security or not, was in other ways inconvenient and very expensive. about the same time certain other reforms, obvious as they seem to us since the days of florence nightingale, were tried in various places, tending to more careful organization and to greater cleanliness; but till the cause of the mischief could be discovered, only varying results could be obtained, and no real victory could be won. hence a radical policy like simpson’s met with considerable support. in days when many surgeons submitted despairingly to what they regarded as inevitable, it was an advantage to have any one boldly advocating a big measure; and simpson had sufficient prestige in edinburgh and outside to carry many along with him. but before 1869 another line of attack had been initiated from glasgow, and lister was already applying principles which were to win the battle with more certainty of permanent success.
glasgow was no more free from these troubles than other great towns; in fact it suffered more than most of them. with its rapid industrial development it had already in 1860 a population of 390,000. its streets were narrow, its houses often insanitary. in the haste to make money its citizens had little time to think of air and open spaces. the science of town-planning was unborn. its hospital, far from having any special advantage of position, was exposed to peculiar dangers. it lay on the edge of the old cathedral graveyard, where the victims of cholera had received promiscuous pit-burial only ten years before. the uppermost tier of a multitude of coffins reached to within a few inches of the surface. these horrors have long been swept away; but, when lister took charge of his wards in the infirmary, they were infected by the poisonous air generated so close at hand, and in consequence they presented a gruesome appearance. the patients came from streets which often were foul with dirt, smoke, and disease, and were admitted to gloomy airless wards, where pyaemia or gangrene were firmly established. in such an environment certain death seemed to await them.
though his heart must have sunk within him, lister set himself bravely to the task of fighting these grim adversaries. for two years, indeed, he was chiefly occupied with routine work and practical improvements; but he continued his speculations, and in 1861 an article on amputations which he contributed to the system of surgery, a large work in four volumes published in london, showed that he had not lost his power of surveying questions broadly and examining them with a fresh and original insight. he was not in danger of letting his mind be swamped with details, but could put them in their place and subordinate them to principles; and his article is chiefly directed to a philosophical survey which would enable his readers to go through the same process of education which he had followed out for himself. sir hector cameron, the most constant of his glasgow disciples, once illustrated this philosophic spirit from a passage in cicero contrasting the many scientists who ‘render themselves familiar with the strange’ (not realizing that it is strange or needs explanation) with the few who ‘render themselves strange to the familiar’— who stand away from the phenomena to which every one has become too accustomed and examine them afresh for themselves. in lister he recognized the peculiar gift which enabled him to rise superior to his subject, and to interpret what was to his colleagues a sealed book. in these days, among the too familiar scourges of the hospital, his work was perpetually putting questions to him; to a man whose mind was open the answer might come at any moment and from any quarter.
as a fact, already, far from his own circle and for a long while out of his ken, there was working in france the most remarkable scientist of the century, louis pasteur, who more than once put his scientific ability at the disposal of a stricken industry, and in his quiet laboratory revived the industrial life of a teeming population. a manufacturer who was confronted with difficulties in making beetroot-alcohol and was threatened with financial ruin, appealed for his help in 1856; and pasteur spent years on the study of fermentation, making countless experiments to test the action of the air in the processes of putrefaction, and coming to the conclusion that the oxygen of the air was not responsible for them, as was widely believed. he went further and reached a positive result. he satisfied himself that putrefaction was set up by tiny living organisms carried in the dust of the air, and that the process was due to what we now familiarly term ‘germs’ or ‘microbes’. the existence of these infinitesimal creatures was known already to scientists, but their importance was not grasped till pasteur, in the years 1862 to 1864, expounded the results of his long course of studies. he himself was no expert in medicine, but his discovery was to bear wonderful fruit when it was properly applied to the science of health and disease. lister’s study of open wounds, his observation of the harm done to the tissues in them when vitality was impaired, and of the value of protective scabs when they formed, enabled him to see the way and to point it out to others. when in 1865 he first read the papers which pasteur had been publishing, he found the principle for which he had so long been searching. with what excitement he read them, with what suddenness of conviction he accepted the message, we do not know; he has left no record of his feelings at the time: but it was the most important moment in his career, and the rest of his life was spent in applying these principles to his professional work.
with his mind thus fortified by the knowledge of the true source of the mischief, realizing that he had to assist in a battle between the deadly germs carried in the air and the living tissues trying to defend themselves, lister returned afresh to the study of methods. he knew that he had to reckon with germs in the wound itself, if the skin was broken, with germs on the hands and instruments of the operator, and with germs on the dust in the air. he must find some defensive power which was able to kill the germs, at least in the first two instances, without exercising an irritating effect on the tissues and weakening their vitality. the relative importance of these various factors in the problem only time and experience could tell him. carbolic acid had been discovered in 1834 and had already been tried by surgeons with varying results. at carlisle it had been used by the town authorities to cope with the foul odour of sewage, and lister visited the town to study its operation. in its cruder form carbolic proved only too liable to irritate a wound and was difficult to dissolve in water. lister tried solutions of different strengths, and finally arrived at a form of carbolic acid which proved to be soluble in oil and to have the ‘antiseptic’ force which he desired — that is, to check the process of sepsis or putrefaction inside the wound. he also set himself to devise some ‘protective’ which would enable nature to do her healing work without further interference from without. animals have the power to form quickly a natural scab over a wound, which is impermeable and at the same time elastic. the human skin, after a slight wound, in a pure atmosphere, may heal quickly; but a serious wound may continue open for a long time, discharging ‘pus’ at intervals, while decomposition is slowly lowering the vitality of the patient. lister made numerous experiments with layers of chalk and carbolic oil, with a combination of shellac and gutta-percha, with everything of which he could think, to imitate the work of nature. his inexhaustible patience stood him in good stead in all these practical details. rivals might speak contemptuously of the ‘carbolic treatment’ and the ‘putty method’ as if he were the vender of a new quack medicine; but at the back of these details was a scientific principle, firmly grasped by one man, while all others were groping in the dark.
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 universities48 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.
this was due to the introduction of the so-called aseptic theory so widely prevalent to-day, of which the chief prophet in 1885 was professor von bergmann of berlin. into the relative merits of systems, on which the learned disagree, it is absurd for laymen to enter; nor is it necessary to make such comparisons in order to appreciate the example of lister’s life. the new school believe that they have gained by the abandonment of carbolic and other antiseptics which may irritate a wound and by trusting to the agency of heat for killing all germs. but lister himself took enormous pains to keep his antiseptic as remote as possible from the tissues to whose vitality he trusted, and went half-way to meet the aseptic doctrine. if he retained a belief in the need for carbolic and distrusted the elaborate ritual of the modern hospital, with its boiling of everybody and everything connected with an operation, it was not either from blindness or from pettiness of mind. as in the case of abandoning the spray, it was his love of simplicity which influenced him. if the detailed precautions of the complete aseptic system are found practicable and beneficial in a hospital, they are difficult to realize for a country surgeon who has to work in a humbler way, and lister wished his procedure to be within reach of every practitioner who needed it.
one more point must be considered before pronouncing listerism to be superseded. in time of war there are occasions when necessity dictates the treatment to be followed. wounded men, picked up on the field of battle some hours after they were hit, are not fit subjects for a method that needs a clear field of operation. it is then too late for aseptic precautions, as the wound may already be teeming with bacteria. only the prompt use of carbolic can stay the ravages of putrefaction; and lister’s method, so often disparaged, must have saved the lives of thousands during the late war.
in any case there is much common ground between the two schools: each can learn from the other, and those professors of asepticism who have acknowledged their debt to lister have been wiser than those who have made contention their aim. this was never the spirit in which he approached scientific problems.
an earlier controversy, in which his name was involved, was that which raged round the practice of vivisection. here lister had practically the whole of his profession behind him when he boldly supported the claims of science to have benefited humanity by the experiments conducted on animals and to have done so with a minimum of suffering to the latter. and it was well that science had a champion whose reputation for gentleness and moderation was so well established. queen victoria herself showed a lively interest in this fiercely-debated question; and in 1871, when lister was appealed to by sir henry ponsonby, her private secretary, to satisfy her doubts on the subject, he wrote an admirable reply, calm in tone and lucid in statement, in which he showed how unfounded were the charges brought against his profession.
in 1892 his professional career was drawing to a close. in that year he received the heartiest recognition that france could give to his work, when he went there officially to represent the royal society at the pasteur celebration. a great gathering of scientists and others, presided over by president carnot, came together at the sorbonne to honour pasteur’s seventieth birthday. it was a dramatic scene such as our neighbours love, when the two illustrious fellow workers embraced one another in public, and the audience rose to the occasion. to be acclaimed with pasteur was to lister a crowning honour; but a year later fortune dealt him a blow from which he never recovered. his wife, his constant companion and helper, was taken ill suddenly at rapallo on the italian riviera, and died in a few days; and lister’s life was sadly changed.
he was still considerably before the public for another decade. he did much useful work for the royal society, of which he became foreign secretary in 1893 and president from 1895 to 1900. he visited canada and south africa, received the freedom of edinburgh in 1898 and of london in 1907, and in 1897 he received the special honour of a peerage, the only one yet conferred on a medical man. he took an active interest in the discoveries of koch and metchnikoff, preserving to an advanced age the capacity for accepting new ideas. he was largely instrumental in founding the institute of preventive medicine now established at chelsea and called by his name. but his work as a surgeon was complete before death separated him from his truest helper. in 1903 his strength began to fail, and for the last nine years of his life, at london or at walmer, he was shut off from general society and lived the life of an invalid.
in 1912 he passed away by almost imperceptible degrees, in his home by the sea, and by his own request was buried in the quiet cemetery of west hampstead where his wife lay. a public service was held in westminster abbey, and a portrait medallion there preserves the memory of his features. the patient toil, the even temper, the noble purpose which inspired his life, had achieved their goal — he was a national hero as truly as any statesman or soldier of his generation; and if, according to his nature he wished his body to lie in a humble grave, he deserved full well to have his name preserved and honoured in our most sacred national shrine.
