Joseph Lister

Early life

Lister was born to a prosperous, educated Quaker family in the village of Upton, then near but now in London, England. He was the fourth child and second son of four sons and three daughters born to gentleman scientist and wine merchant Joseph Jackson Lister and school assistant Isabella Lister née Harris. The couple married in a ceremony held in Ackworth, West Riding of Yorkshire on 14 July 1818.

Lister's paternal great-great-grandfather, Thomas Lister was the last of several generations of farmers who lived in Bingley, West Riding of Yorkshire. Lister joined the Society of Friends as a young man and passed his beliefs on to his son, Joseph Lister. He moved to London in 1720 to open a tobacconist's shop in Aldersgate Street in the City of London. His son, John Lister, was born there. Lister's grandfather was apprenticed to watchmaker Isaac Rogers, in 1752 and followed that trade on his own account in Bell Alley, Lombard Street from 1759 to 1766. He then took over his father's tobacco business, but gave it up in 1769 in favour of working at his father-in-law Stephen Jackson's business as a wine-merchant at No 28 Old Wine and Brandy Values on Lothbury Street, opposite Tokenhouse Yard.

His father was a pioneer in the design of achromatic object lenses for use in compound microscopes He spent 30 years perfecting the microscope, and in the process, discovered the Law of Aplanatic Foci, building a microscope where the image point of one lens coincided with the focal point of another. Up until that time, the best higher magnification lenses produced an excessive secondary aberration known as a coma, which interfered with normal use. It was considered a major advance that elevated histology into an independent science. By 1832, Lister's work had built a reputation sufficient to enable his being elected to the Royal Society. His mother, Isabella, was the youngest daughter of master mariner Anthony Harris. Isabella worked at the Ackworth School, a Quaker school for the poor, assisting her widowed mother, the superintendent of the school.

The eldest daughter of the couple was Mary Lister. On 21 August 1851, she married the barrister Rickman Godlee of Lincoln's Inn and the Middle Temple, who belonged to the Friends meeting house in Plaistow. The couple had six children. Their second child was Rickman Godlee, a neurosurgeon who became Professor of Clinical Surgery at the University College Hospital and surgeon to Queen Victoria. He became Lister's biographer in 1917. The eldest son of Joseph and Isabella Lister was John Lister, who died of a painful brain tumour. With John's death, Joseph became the heir of the family. The couple's second daughter was Isabella Sophia Lister, who married Irish Quaker Thomas Pim in 1848. Lister's other brother William Henry Lister died after a long illness. The youngest son was Arthur Lister, a wine merchant, botanist and lifelong Quaker, who studied Mycetozoa. He worked alongside his daughter Gulielma Lister to produce the standard monograph on Mycetozoa. By 1898, Lister's work had built a reputation sufficient to enable his election to the Royal Society. Gulielma Lister, a talented artist, later updated the standard monograph with colour drawings. Her work built a reputation sufficient to be elected a fellow of the Linnean Society in 1904. She became its vice-president in 1929. The couple's last child was Jane Lister; she married widower Smith Harrison, a wholesale tea merchant.

Education

School

As a child, Lister had a stammer and this was possibly why he was educated at home until he was eleven. Lister then attended Isaac Brown and Benjamin Abbott's Academy, a private Quaker school in Hitchin, Hertfordshire. When Lister was thirteen, he attended Grove House School in Tottenham, also a private Quaker School to study mathematics, natural science, and languages. His father was insistent that Lister received a good grounding in French and German, in the knowledge he would learn Latin at school. From an early age, Lister was strongly encouraged by his father and would talk about his father's great influence later in life, particularly in encouraging him in his study of natural history. Lister's interest in natural history led him to study bones and to collect and dissect small animals and fish that were examined using his father's microscope and then drawn using the camera lucida technique that his father had explained to him, or sketched. His father's interests in microscopical research developed in Lister the determination to become a surgeon and prepared him for a life of scientific research. None of Lister's relatives were in the medical profession. According to Godlee, the decision to become a physician seemed to be an entirely spontaneous decision.

In 1843 his father decided to send him to university. As Lister was unable to attend either University of Oxford or the University of Cambridge owing to the religious tests that effectively barred him, he decided to apply to the non-sectarian University College London Medical School (UCL), one of only a few institutions in Great Britain that accepted Quakers at that time. Lister took the public examination in the junior class of botany, a required course that would enable him to matriculate. Lister left school in the spring of 1844 when he was seventeen.

University

In 1844, just before Lister's seventeenth birthday, he moved to an apartment at 28 London Road that he shared with Edward Palmer, also a Quaker. Between 1844 and 1845, Lister continued his pre-matriculation studies, in Greek, Latin and natural philosophy. In the Latin and Greek classes, he won a "Certificate of Honour". For the experimental natural philosophy class, Lister won first prize and was awarded a copy of Charles Hutton's "Recreations in Mathematics and Natural Philosophy".

Although his father wanted him to continue his general education, the university had demanded since 1837, that each student obtain a Bachelor of Arts (BA) degree before commencing medical training. Lister matriculated in August 1845, initially studying for a BA in classics. Between 1845 and 1846, Lister studied the mathematics of natural philosophy, mathematics and Greek earning a "Certificate of Honour" in each class. Between 1846 and 1847, Lister studied both anatomy and atomic theory (chemistry) and won a prize for his essay. On 21 December 1846, Lister and Palmer attended Robert Liston's famous operation where ether was applied by Lister's classmate, William Squire to anaesthetise a patient for the first time. On 23 December 1847, Lister and Palmer moved to 2 Bedford Place and were joined by John Hodgkin, the nephew of Thomas Hodgkin who discovered Hodgkin lymphoma. Lister and Hodgkin had been school friends.

In December 1847, Lister graduated with a degree of Bachelor of Arts 1st division, with a distinction in classics and botany. While he was studying, Lister suffered from a mild bout of smallpox, a year after his elder brother died of the disease. The bereavement combined with the stress of his classes led to a nervous breakdown in March 1848. Lister's nephew Godlee used the term to describe the situation and is perhaps indicative that adolescence was just as difficult in 1847, as it is now. Lister decided to take a long holiday to recuperate and this delayed the start of his studies. In late April 1848, Lister visited the Isle of Man with Hodgkin and by 7 June 1848, he was visiting Ilfracombe. At the end of June, Lister accepted an invitation to stay in the home of Thoman Pim, a Dublin Quaker. Using it as his base, Lister travelled throughout Ireland. On 1 July 1848, Lister received a letter full of warmth and love from his father where his last meeting was "...sunshine after a refreshing shower, following a time of cloud" and advised him to "cherish a pious cheerful spirit, open to see and to enjoy the bounties and the beauties spread around us :—not to give way to turning thy thoughts upon thyself nor even at present to dwell long on serious things". From 22 July 1848, for more than a year, the record is blank.

Medical student

Lister registered as a medical student in the winter of 1849 and became active in the University Debating Society and the Hospital Medical Society. In the autumn of 1849, he returned to college with a microscope given to him by his father. After completing courses in anatomy, physiology and surgery, he was awarded a "Certificate of Honours", winning the silver medal in anatomy and physiology and a gold medal in botany.

His main lecturers were John Lindley professor of botany, Thomas Graham professor of chemistry, Robert Edmond Grant professor of comparative anatomy, George Viner Ellis professor of anatomy and William Benjamin Carpenter professor of medical jurisprudence. Lister often spoke highly of Lindley and Graham in his writings, but Wharton Jones professor of ophthalmic medicine and surgery, and William Sharpey professor of physiology, exercised the greatest influence on him. He was greatly attracted by Dr. Sharpey's lectures, which inspired in him a love of experimental physiology and histology that never left him.

Thomas Henry Huxley praised Wharton Jones for the method and quality of his physiology lectures. As a clinical scientist working in physiological sciences, he was foremost in the number of discoveries he made. He was also considered a brilliant ophthalmic surgeon, his main field. He conducted research into the circulation of blood and the phenomena of inflammation, carried out on the frog's web and the bat's wing, and no doubt suggested this method of research to Lister. Sharpey was called the father of modern physiology as he was the first to give a series of lectures on the subject. Prior to that the field had been considered part of anatomy. Sharpey studied at Edinburgh University, then went to Paris to study clinical surgery under French anatomist Guillaume Dupuytren and operative surgery under Jacques Lisfranc de St. Martin. Sharpey met James Syme while in Paris and the two became life-long friends. After he moved to Edinburgh he taught anatomy with Allen Thomson as his physiological colleague. He left Edinburgh in 1836, to become the first Professor of Physiology.

To qualify for his degree, Lister had to complete two years of clinical instruction, and began his residency at University College Hospital in October 1850. as an intern and then house physician to Walter Hayle Walshe, professor of pathological anatomy and author of the 1846 study, The Nature and Treatment of Cancer. Lister in 1850 again received "Certificates of Honours" and won two gold medals in anatomy and a silver medal each in surgery and medicine.

Graduation

Lister graduated with a Bachelor of Medicine with honours in the autumn of 1852. During his final year, Lister won several prestigious awards heavily contested among the student body of London teaching hospitals. He won the Longridge Prize

For the greatest proficiency evinced during the three years immediately preceding, on the Sessional Examinations for Honours in the classes of the Faculty of Medicine of the College; and for creditable performance of duties of offices at the Hospital

that included a £40 stipend. He was also awarded a gold medal in structural and physiological botany. Lister won two of the four available gold medals in anatomy and physiology as well as surgery, which came with a scholarship of £50 a year for two years, for his second examination in medicine. In the same year, Lister passed the examination for the fellowship of the Royal College of Surgeons, bringing to a close nine years of education.

Sharpey advised Lister to spend a month at the medical practice of his lifelong friend James Syme in Edinburgh and then visit medical schools in Europe for a longer period for training. Sharpey himself had been taught first in Edinburgh and later in Paris. Sharpey had met Syme, a teacher of clinical surgery widely considered the best surgeon in the United Kingdom while he was in Paris. Sharpey had gone to Edinburgh in 1818, along with many other surgeons since, due to the influence of John Hunter. Hunter had taught Edward Jenner, seen as the first surgeon to take a scientific approach to the study of medicine, known as the Hunterian method Hunter was an early advocate for careful investigation and experimentation, using the techniques of pathology and physiology to give himself a better understanding of healing than many of his colleagues. For example, his 1794 paper, A treatise on the blood, inflammation and gun-shot wounds was the first systematic study of swelling, discovering that inflammation was common to all diseases. Due to Hunter, surgery, then practised by hobbyists or amateurs, became a true scientific profession. As the Scottish universities taught medicine and surgery from a scientific viewpoint, surgeons who wished to emulate those techniques travelled there for training. Scottish universities had several other features that distinguished them from those in the south. They were inexpensive and did not require religious admissions tests, and thus attracted the most scientifically progressive students in Britain. The most important differentiator was that medical schools in Scotland had evolved from a scholarly tradition, where English medical schools relied on hospitals and practice. Experimental science had no practitioners at English medical schools and while Edinburgh University medical school was large and active at the time, southern medical schools were generally moribund, and their laboratory space and teaching materials inadequate. English medical schools also tended to view surgery as manual labour, not a respectable calling for a gentleman academic.

Surgical profession 1854

Before Lister's studies of surgery, many people believed that chemical damage from exposure to "bad air", or miasma, was responsible for infections in wounds. Hospital wards were occasionally aired out at midday as a precaution against the spread of infection via miasma, but facilities for washing hands or a patient's wounds were not available. A surgeon was not required to wash his hands before seeing a patient; in the absence of any theory of bacterial infection, such practices were not considered necessary. Despite the work of Ignaz Semmelweis and Oliver Wendell Holmes Sr., hospitals practised surgery under unsanitary conditions. Surgeons of the time referred to the "good old surgical stink" and took pride in the stains on their unwashed operating gowns as a display of their experience.

Edinburgh 1853–1860

James Syme

Syme, a well-established clinical lecturer at Edinburgh University for more than two decades before he met Lister, was considered the boldest and most original surgeon then living in Great Britain. He became a surgical pioneer during his career, preferring simpler surgical procedures, as he detested complexity, in the era that immediately preceded the introduction of anaesthesia.

In September 1823, at the age of 24, Syme made a name for himself by first performing an amputation at the hip-joint, the first in Scotland. Considered the bloodiest operation in surgery, Syme completed it in less than a minute, as speed was essential at that time, before anaesthesia. Syme became widely known and acclaimed for developing a surgical operation that became known as Syme amputation, an amputation at the ankle where the foot is removed and the heel pad is preserved. Syme was considered a scientific surgeon, as evidenced by his paper On the Power of the Periosteum to form New Bone, and became one of the first advocates of antiseptics.

Arrival in Edinburgh

In September 1853, Lister arrived in Edinburgh bearing letters of introduction from Sharpey to Syme. Lister was anxious about his first appointment but decided to settle in Edinburgh after meeting Syme, who embraced him with open arms, invited him to dinner, and offered him an opportunity to assist him in his private operations.

Lister was invited to Syme's house Millbank in Morningside (now part of Astley Ainslie Hospital), where he met, amongst others, Agnes Syme, Syme's daughter from another marriage and granddaughter of physician Robert Willis. While Lister thought that Agnes was not conventionally pretty, he admired her quickness of mind, her familiarity with medical practice, and her warmth. He became a frequent visitor to Millbank and met a much wider group of eminent people than he would have in London.

In the same month, Lister began assisting Syme at the University of Edinburgh In a letter to his father, Lister expressed surprise at the size of the infirmary and spoke about his impressions of Syme, "..is larger than I expected to find it; there are 200 Surgical beds, and a large number in other departments. At University College Hospital there were only about 60 Surgical beds, so altogether a prospect appears to be opening of a very profitable stay here. ...Syme is, I suppose, the first of British surgeons, and to observe the practice and hear the conversation of such a man is of the greatest possible advantage". By October 1853, Lister decided to spend the winter in Edinburgh. Syme was so impressed by Lister, that after a month Lister became Syme's supernumerary house surgeon at the Royal Infirmary of Edinburgh and his assistant in his private hospital at Minto House in Chambers Street. As house surgeon, Lister assisted Syme during every operation, taking notes. It was a much-coveted position and gave Lister the option of choosing which of the ordinary cases he would attend. During this period, Lister presented a paper at the Royal Edinburgh Medico-Chirurgical Society on the structure of cancellous exostoses that had been removed by Syme, demonstrating that the method of ossification of these growths is the same as that which occurs in epiphyseal cartilage.

In September 1854, Lister's house surgeoncy appointment was finished. With the prospect of being out of a job, he spoke to his father about seeking a position at the Royal Free Hospital in London. However, Sharpey had written to Syme warning him that it was unlikely that Lister would be welcome at the Royal Free as he would have likely eclipsed Thomas H. Wakley, whose father held considerable sway at the hospital. Lister then made plans to tour Europe for a year. However, an opportunity presented itself with the death of noted infirmary surgeon and surgical lecturer at the Edinburgh Extramural School of Medicine Richard James Mackenzie. Mackenzie had been seen as a successor to Syme but had contracted cholera in Balbec in Scutari, Istanbul, while on a four-month volunteer sabbatical as field surgeon to the 79th Highlanders during the Crimean War. Lister proposed to Syme that he take over Mackenzie's position and become assistant surgeon to Syme. Syme initially rejected the idea, as Lister was not licensed to operate in Scotland, but later warmed to the idea. In October 1854, Lister was appointed as a lecturerLister successfully transferred the lease held by Mackenzie at his lecture room at 4 High School Yards, to himself. On 21 April 1855, Lister was elected a Fellow of the Royal College of Surgeons of Edinburgh and two days later rented a home at 3 Rutland Square. In June 1855, Lister made a hurried trip to Paris to take a course on operative surgery on the dead body and returned in June.

Extramural lecturing

On 7 November 1855, Lister gave his first extramural lecture on the "Principles and Practice of Surgery", in a lecture theatre at 4 High School Yards known as Old Jerusalem, directly located across from the infirmary. His first lecture was read from 21 pages of foolscap folio. Lister's first lectures were based on notes, either read or spoken, but over time he used notes less and less, becoming extempore in his speech, slowly and deliberately forming his argument as he went along. With this deliberate way of speaking, he managed to overcome a slight, occasional stammer which in his early days had been more pronounced.

His first student was John Batty Tuke, in a class of nine or ten, mostly consisting of dressers. Within a week, twenty-three people had joined. In the next year, only eight people turned up. In the summer of 1858, Lister had the ignominious experience of reading his lecture to a single student, who arrived ten minutes late. Seven more students arrived later.

His first lecture focused on the concept of surgery, giving a definition of disease that linked it to the Hippocratic Oath. He then explained that surgery could have more benefits than medicine, which could only comfort the patient at best. He then explained the attributes a good surgeon should exhibit, before finishing the lecture by recommending Syme's book "Principles of Surgery". Lister completed 114 lectures that followed a standard syllabus. Lecture VII described his earliest experiment on inflammation, where he put mustard on his arm and watched the results. Lectures IV to IX dealt with the circulation of blood. Inflammation was discussed in lectures X to XIII. The second half of the course dealt with clinical surgery. For the last four days, he gave two lectures a day, to complete the event before his wedding, with the first course ending on 18 April 1856. In the summer of 1858, Lister started a second, completely separate course, where he lectured on surgical pathology and operative surgery.

Marriage

By mid-summer 1854, Lister had started to court Agnes Syme. Lister wrote to his parents about his love but they worried about the union, particularly since he was Quaker and Agnes had given no indication that she would change her denomination. At that time when a Quaker married a person of another denomination, it was considered as marrying out of the society. Lister was determined to marry Agnes and sent a further letter to his father, asking him if his financial support would continue should Lister and Agnes marry. Lister's father replied that Agnes not being in the Society of Friends would not affect his pecuniary arrangements and offered his son extra money to buy furniture and suggested that Syme would offer a dowry and that he would negotiate with Syme directly on it. His father suggested that Lister voluntarily resign from the Society of Friends. Lister made up his mind and subsequently left the Quakers to become a Protestant, later joining the congregation of the Saint Paul's Episcopal Church in Jeffrey Street, Edinburgh. In August 1855, Lister became engaged to Agnes Syme and on 23 April 1856 married her in the drawing room of Millbank, Syme's house in Morningside. Agnes's sister stated that this was out of consideration of any Quaker relations. Only the Syme family were present. The Scottish physician and family friend John Brown toasted the couple after the reception.

The couple spent a month at Upton and the Lake District, followed by a three-month tour of the leading medical institutes in France, Germany, Switzerland, and Italy. They returned in October 1856. By this time, Agnes was enamoured with medical research and became Lister's partner in the laboratory for the rest of her life. When they returned to Edinburgh, the couple moved into a rented house at 11 Rutland Street in Edinburgh. The house was situated over three floors with a study on the first floor, that was converted into a consulting room for patients and a room with hot and cold taps on the second floor that became his laboratory. The Scottish surgeon Watson Cheyne, who was almost a surrogate son to Lister, stated after his death that Agnes had entered into her work wholeheartedly, had been his only secretary, and that they discussed his work on an almost equal footing.

Lister's books are full of Agnes' careful handwriting. Agnes would take dictation from Lister for

hours at a stretch. Spaces would be left blank amongst the reams of Agnes' handwriting for small diagrams, that Lister would create using the camera lucida technique and Agnes would later paste in.

Assistant surgeoncy

On 13 October 1856, he was unanimously elected to the position of Assistant Surgeoncy at Edinburgh Royal Infirmary.

Contributions to physiology and pathology 1853–1859

Between 1853 and 1859 in Edinburgh, Lister conducted a series of physiological and pathological experiments. His approach was rigorous and meticulous in both measurement and description. Lister was clearly aware of the latest advances in physiological research in France, Germany, and other European countries and maintained an ongoing discussion of his observations and results with other leading physicians in his peer group including Swiss physiologist Albert von Kölliker, German physiologists Wilhelm von Wittich, Theodor Schwann, and German pathologist Rudolf Virchow and ensured he correctly cited their work.

Lister's primary instrument of research was his microscope and his primary research subjects were frogs. Before his honeymoon, the couple had visited his uncle's house in Kinross. Lister took his microscope and captured several frogs, intending to use them in the study of inflammation, but they escaped. When he returned from his honeymoon, he used frogs captured from Duddingston Loch in his experiments. Lister carried out his experiments in his laboratory and in the veterinary college abattoir, on animals that were either dead or chloroformed and pithed, to deprive it of sensation. He also used bats, sheep, cats, rabbits, oxen and horses in his experiments. Lister's tirelessness in his pursuit of knowledge was illustrated by his assistant Thomas Annandale, who stated:

I confess that on more than one occasion our patience was a little tried by the long hours were thus engaged, and more particularly when the dinner hour was many hours overdue, but no one could work with Mr. Lister without imbibing some of his enthusiasm.

These experiments resulted in the publication of eleven papers between 1857 and 1859. They included the study of the nervous control of arteries, the earliest stages of inflammation, the early stages of coagulation, the structure of nerve fibres, and the study of the nervous control of the gut with reference to sympathetic nerves. He continued these experiments for three years until he was appointed to a position at the University of Glasgow.

In a letter dated 16 September 1855, Lister recorded the beginnings of his research into inflammation, six weeks before his lectures were to begin. Later in life, Lister stated that he considered his research into inflammation to have been an "essential preliminary" to his conception of the antiseptic principle and insisted that these early findings be included in any memorial volume of his work. In 1905, when he was seventy-eight years old, he wrote,

Glasgow appointment

On 1 August 1859, Lister wrote to his father to inform him of the ill-health of James Adair Lawrie, Regius Professor of Surgery at the University of Glasgow, believing he was close to death. The anatomist Allen Thomson had written to Syme to inform him of Lawrie's condition and that it was his opinion that Lister was the most suitable person for the position. Lister stated that Syme believed he should become a candidate for the position. He went on to discuss the merits of the post; a higher salary, being able to undertake more surgery and being able to create a bigger private practice. Lawrie died on 23 November 1859. In the following month, Lister received a private communication, although baseless, that confirmed he had received the appointment. However, it was clear the matter was not settled when a letter appeared in the Glasgow Herald on 18 January 1860 that discussed a rumour that the decision had been handed over to the Lord Advocate and officials in Edinburgh. The letter annoyed the members of the governing body of Glasgow University, the Senatus Academicus. The matter was referred to the Vice-Chancellor Thomas Barclay who tipped the decision in favour of Lister. On 28 January 1860, Lister's appointment was confirmed.

Glasgow 1860–1869

University life

To be formally inducted into the academic staff, Lister had to deliver a Latin oration before the senatus academicus. In a letter to his father, he described how surprised he was when a letter arrived from Allen Thomson informing him that the thesis had to be presented the next day on 9 March. Lister unable to start the paper until 2 a.m. that night, had only prepared around two-thirds of it, when he arrived in Glasgow. The rest was written at Thomson's house. In the letter, he described the dread he felt being admitted into the room prior to presenting the oration. After the thesis was read and Lister was inducted to the senate, he signed a statement not to act contrary to the wishes of the Church of Scotland. While the contents of his thesis have been lost, the title is known: De Arte Chirurgica Recte Erudienda ("On the proper way of teaching the art of surgery").

In early May 1860, the couple made the journey to Glasgow to move into their new house at 17 Woodside Place, at the time on the western edge of the city. In 1860, university life in Glasgow was lived in the grimy quadrangles of the small college on Glasgow High Street, a mile east of the city centre next to Glasgow Royal Infirmary (GRI) and the Cathedral and surrounded by the most squalid part of the old medieval city. The Scottish poet and novelist Andrew Lang wrote of his student days at the college, that while Coleridge could smell 75 different stenches during his student days in Cologne, Lang counted more. The city was so polluted the grass did not grow.

The position of Professor of Surgery at Glasgow was peculiar, as it did not carry with it an appointment as surgeon to the Royal Infirmary, as the university was separate from the hospital. The allotment of surgical wards to the care of the Professor of Surgery depended upon the goodwill of the directors of the infirmary. His predecessor Lawrie never held any hospital appointments at all. Having no patients to care for, Lister immediately began a summer lecture course. He discovered that college classrooms were considered too small and had low ceilings for the number of students, which made them unpleasant to be in when filled to overcrowding. Before his first lecture, the couple cleaned and painted the dingy lecture room assigned to them, at their own expense. He inherited a large class of students from his predecessor that grew rapidly.

After his first session, he wrote favourably of Glasgow:

Election to surgeoncy

In August 1860, Lister had been rejected for a post at the Royal Infirmary by David Smith, a shoemaker who was the chairman of the hospital board. When Lister put his case to Smith explaining the need for anatomical demonstrations so the students could understand the practice of surgery, Smith stated his belief that "the infirmary was a curative institution, not an educational one". The rejection both annoyed and surprised Lister as he had been promised by Thomson that the position was assured. Indeed, he had informed his father of the fact that the post was guaranteed in his letter to his father.

In November 1860, the winter lecture course began. In total 182 students registered for the lectures and according to Godlee it was likely the "largest class of systematic surgery in Great Britain, if not in Europe". The class consisting of mostly 4th year students with some 3rd and 2nd year students, was so enthused, that they decided to make Lister the Honorary President of their Medical Society. When the time approached for the election to the surgeoncy in 1861, 161 students signed a petition on parchment supporting his claim for election. Lister was not elected until 5 August 1861, in what was described by Beck as a "troublesome canvas". Lister was put in charge of wards XXIV (24) and XXV (25) in October 1861. It was not until November 1861 that he performed his first public operation. Soon after Lister arrived at the GRI, a new surgical block was built and it was here that he conducted many of his trials of antisepsis.

Holmes System of Surgery

Between the end of his winter lecture course and his appointment, Lister's correspondence contained little of scientific interest. A letter to his father dated 2 August 1861 explained why. He had halted his experiments on coagulation to work on two chapters, "Amputation" and "On Æsthetics" (On anaesthetics) for the medical reference work System of Surgery by Timothy Holmes, published in four volumes in 1862. Chloroform was Lister's preferred anaesthetic. He wrote three papers for Holmes in 1861, 1870 and 1882. The science of anaesthesia was in its infancy when Lister first recommended chloroform to Syme in 1855, and he continued to use it until the 1880s. His sister Isabella Sophie first described it to him in 1848 when she had a tooth pulled. He had also used it without complications on three patients with tumours of the jaw in 1854. He classed it along with alcohol and opium as a "specific irritant" in "On the early stages of imflammation". Lister preferred it to ether, as it was safer to use in artificial light, protected the heart and blood vessels, and, Lister believed, gave the patient "mental tranquility" as it was the safest. In the 1871 edition, he reported that there had been no deaths in the Edinburgh or Glasgow infirmaries from chloroform, between 1861 and 1870. Lister described how his assistant applied the chloroform onto a simple handkerchief used as a mask and watched the patient's breathing. In 1870 however Lister updated the chapter to state that he felt apprehension about using chloroform on the "aged and infirm". In the same edition he recommended nitrous oxide for tooth extraction and the use of ether to avoid vomiting after abdominal surgery. In the winter of 1873, the English medical journals reported that sulphuric ether should be used instead but Watson Cheyne stated there had been no deaths from chloroform during the winter of 1873. In 1880, the British Medical Association recommended the synthetic gas ethidene dichloride for clinical trials. On 14 November 1881, Paul Bert published the dose-response curve of chloroform but Lister believed that smaller doses were sufficient to anaesthetise the patient. Starting in April 1882, Lister first conducted clinical research using ether and from July to November, lab experiments on chaffinches and then on himself and Agnes, to determine the correct dose. The 1882 chapter continued to recommend chloroform.

The chapter on amputation was much more technical than the anaesthesia chapter, for example describing the ways of cutting the skin to produce flaps to close over the wound. In the first edition, Lister examined the history of amputation from Hippocrates to Thomas Pridgin Teale, William Hey, François Chopart, Nikolay Pirogov and Dominique Jean Larrey and the discovery of the tourniquet by Etienne Morel. In the first edition, Lister devoted seven pages to dressings, but by the third edition used only a single sentence to recommend a dry dressing as opposed to the more common water dressing.

Croonian Lecture

On 1 January 1863, Lister returned to the topic of coagulation with the Croonian Lecture titled "On the coagulation of the blood", although it contained little that was new. The lecture, given in London at the invitation of the Royal Society and the Royal College of Physicians, began by reconfirming the fallacious nature of the ammonia theory, instead proposing that shed blood coagulates when the solid and fluid elements of the blood meet. His experiments had confirmed that blood plasma (liquor sanguinis) alone does not coagulate, but does when in contact with red blood cells. Lister suggested that living tissues possessed similar properties in relation to blood coagulation. He mentioned the presence of coagulable fluid in the interstices of cellular tissue and described instances of oedema liquid coagulating after emission, possibly due to a slight admixture of red blood cells. Lister highlighted the tendency of inflamed tissues to induce coagulation in their vicinity, suggesting that inflamed tissues temporarily lose their vital properties and behave like ordinary solids, leading to coagulation. He provided examples of inflamed arteries and veins exhibiting coagulation on their interior, like artificially deprived vessels. Lister then noted that inflamed tissues induce coagulation and oedema effusions remain liquid. He hypothesised that the accumulated red blood cells increased pressure in inflamed capillaries and contributed to the loss of healthy condition in capillary walls, leading to coagulation. In closing, Lister said his previous microscopic investigation published in the Philosophical Transactions, supported the view that tissues could be temporarily deprived of vital power by irritants. He proposed that inflammatory congestion arose from the adhesiveness of red blood cells to irritated tissues, like their behaviour outside the body when encountering ordinary solids. In finishing the lecture, Lister said he was satisfied that his previous conclusions on the nature of inflammation were independently confirmed through his research into blood coagulation.

On excision of the wrist for caries

Lister's most original work that he undertook during 1863 and the beginning of 1864 was the development of a surgical technique for the excision of caries from the wrist, i.e., the removal of diseased bone due to tuberculosis. The procedure consisted of removing the ends of the bones entering into an articulation instead of amputating the whole limb, and was considered a recent development in "conservative surgery". Several surgeons had attempted the procedure. It was first performed by German surgeons Johann von Dietz in 1839 and Johann Ferdinand Heyfelder in 1849, followed by British surgeon William Fergusson in 1851. While the development of techniques for excision of the elbow was largely successful, similar success for the excision of the wrist was elusive, so amputation was still considered the most appropriate treatment even in 1860. Lister developed a complicated technique that removed the tissue where the disease was likely to occur but preserved the structures used to move the fingers and wrist. The technique was adopted by the profession and the only complaint from surgeons was the length of the operation at 90 minutes. Lister waited almost a year before publishing the paper in March 1865 in The Lancet. The paper presented 15 case histories. Of these, ten people were cured, two had hopes of achieving a cure, two died of causes independent of the operation and Lister considered one operation unsatisfactory, a failure rate of 13%.

Edinburgh position

Professor of Systematic Surgery in Edinburgh James Miller died in June 1864. The Edinburgh chair, considered the most prestigious within the Scottish medical community, came with an annual stipend of £700-£800 per year. Syme and his friends suggested that Lister should apply as his candidature was all but assured. A number of reasons have been advanced for why Lister applied. In a letter to his father, he said that he saw Glasgow as a stepping stone. There were a multitude of reasons to either stay or go. He was drawn to research, his friends were there, and he found the routine tasks in Glasgow to be "working in a corner". There was also the fact that his tenure only lasted 10 years. Testimonials from Christison, Paget, Buchanan and Syme followed the application. By the end of June, Lister was convinced the position was his. However, the chair went with James Spence instead. Lister was disappointed and in social settings tended to solipsism in conversation, but by October his father, in a letter said that it was, "very gratifying to learn thy complete reconcilement to remaining at Glasgow".

Before he received the disappointing news, Lister had been called back to Upton as his mother Isabella was on her deathbed. She died on 3 September 1864. His father now lived alone at Upton as the only daughter left at home had married in 1858. Communication with his children became of paramount importance to Joseph Jackson and he started to send Lister a letter every week, stating in October "The thought that thou wilt look for letters from thee weekly, and the letters when they come, are alike gratifying to thy poor father."

Winter lecture course

On 1 November, Lister began the winter lecture course, divided in two: common tissue and organ conditions, and conditions of physiology. His first lectures were on blood, then nerves, then detailed special nerves which explained the process of inflammation. In introducing the subject, he stated that any injury that did not cause death would result in inflammation with the familiar symptoms of redness, swelling and pain. These symptoms indicated "inflammatory congestion", the suspension of vital energy, beginning with red corpuscles adhering together, which was caused by fibrin, which itself was caused by two substances in the blood, one in the blood cells and one in liquor sanguis (plasma). He described two types of inflammation, direct and indirect. He saw direct inflammation as caused by a noxious agent and indirect by "sympathy", an indication that his frame of reference was wholly inadequate. He then provided various examples and examined various types of inflammation such as acute, latent and chronic. The following lectures explained how to alleviate the symptoms of inflammation, by for example elevating a limb to enable blood flow, or reducing tension by draining an abscess. The remarkable aspect of Lister's theory of inflammation was that while the details of his observations were correct, his theoretical structure to explain his observations was completely wrong. Lister's error lay in his belief that inflammation was a "unitary disease", a single underlying disease, when in effect it was a range of conditions. The second division of the lectures focused on the heart, blood vessels, lymphatic system, bones, joints and nerves.

Pasteur

At the end of 1864 or during the spring of 1865 (sources vary) while walking home with Thomas Anderson, the chemistry professor at Glasgow, they discussed putrefaction. Anderson drew Lister's attention to the latest research of the French chemist Louis Pasteur, who had discovered living things that caused fermentation and putrefaction. Lister had not been a wide reader of continental literature, but began reading the weekly journal Comptes rendus hebdomadaires of the French Academy of Sciences in the years 1860–1863, in which Pasteur discussed fermentation and putrefaction.

The two papers that Anderson recommended to Lister were Sur les corpuscules organisés qui existent dans l'atmosphère, examen de la doctrine des générations spontanées (1861) ("On the organised particles that exist in the atmosphere, examination of the doctrine of spontaneous generations"). In this paper, Pasteur disproved the theory of spontaneous generation by showing that life in boiled infusions arose from spores. He also proved that particles in the air could be cultivated; and that if they were introduced from the air into a sterile liquid, they would reappear and multiply in the liquid. The second paper was Pasteur's magnum opus, titled Examen du rôle attribué au gaz oxygène atmosphérique dans la destruction des matières animales et végétales après la mort ("Examination of the role attributed to atmospheric oxygen gas in the destruction of animal and plant matter after death"), published 29 June 1863. The paper concluded that fermentation, putrefaction, and slow combustion destroyed organic matter and that these were necessary processes for life to exist. Pasteur learned that slow combustion was related to the anaerobic conditions when microorganisms were present.

Several other papers would directly influence Lister's work on microorganisms. The third paper was Mémoire sur la fermentation appelée lactique (Extrait par l'auteur) ("Memoir on the so-called lactic acid fermentation (Extracted by the author)"), published in 1857,

which described the discovery of the microbe responsible for fermentation in beer yeast. The fourth paper was Memoire sur la Fermentation Alcoolique ("Memoir on Alcoholic Fermentation"), published in Annales de chimie et de physique in 1860. Pasteur described living microorganisms in yeast, Saccharomyces cerevisiae, that were responsible for the effervescent change that led to fermentation. The last paper by Pasteur was Animalcules infusoires vivant sans gaz oxygène libre et déterminant des fermentations ("Animal Infusoria Living in the Absence of Free Oxygen and their fermentations"). That paper,

Discovery

The serendipitous discovery of Pasteur's work at a time when he was struggling to control post-surgical infections provided a simple explanation for a problem he had long experienced. He was now convinced that infection and suppuration of wounds must be due to entry into the wound of minute living airborne creatures. He recognised that contamination was the vector for infection, realising from the first that the surgeon's hands, dressings and instruments would also be contaminated. However, Pasteur's work confirmed the view Lister had always expressed that contamination came from the air. Lister did not realise the vast and diverse amount of microbial life. As Lister's work at that time derived directly from Pasteur's, Lister probably thought that wound infection was due to a single organism. He had no concept, nor indeed did anybody else, of the vast number of types of germs. Reading the papers did spur him to determine how the hands, dressings and instruments he used could be rid of these ubiquitous organisms and how the wound could be cleared of them.

Pasteur suggested three methods to eliminate microorganisms: filtration, exposure to heat, or exposure to chemical solutions. Lister was particularly interested in the efficacy of filtration and repeated many of Pasteur's experiments in modified form for instruction in his class, but eventually excluded the first two techniques as not applicable for the treatment of wounds.

Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop antiseptic techniques for wounds. In the early months of 1865, he began looking for the most convenient form of antiseptics that could prevent germs from entering the wound. The first of these he tried was Condy's Fluid, a common household disinfectant and a strong oxidising agent, but the patient's limb began to suppurate. He went on to examine a huge range of compounds including Zinc chloride, Salicylic acid, Thymol, Iodine, Mercury cyanide and Zinc cyanide but none were suitable.

Carbolic acid

In 1834, Friedlieb Ferdinand Runge discovered the germicide phenol, then known as carbolic acid, which he derived in an impure form from coal tar. At that time, there was uncertainty as to the relationship of creosote – a chemical that had been used as a preservative on the wood used for railway sleeper and ships to protect the wood from rotting – and carbolic acid. Upon hearing that creosote had been used for treating sewage in Carlisle, Lister obtained a sample from Anderson. Known as "German creosote", it was a thick, smelly tarry substance.

Antiseptic system 1865–1867

The history of antiseptic surgery in the years before 1847, was preventing or treating infection in accidental wounds, often received in battle.

In the 1860s, Lister's assumptions about surgery and theory of pathology were similar to those of his contemporaries.

In early March 1865, Lister conducted his first experiment using the acid on a patient whose wrist was being excised due to caries. Although he carefully washed the wound, it became infected and the experiment was a failure.

On 21 March 1865, Lister began his second experiment with carbolic acid on a 22-year-old patient named Neil Kelly who had a severe compound fracture of the leg. His treatment consisted of cleaning the wound of all blood clots. Then a piece of calico or lint soaked in undiluted carbolic acid (phenol) was used to swab the whole wound using forceps. Two pieces of lint impregnated in the undiluted acid was then laid on the leg, overlapping the wound and fixed by an adhesive plaster. A thin metal sheet made of block tin or lead, moulded to the shape of the wound and sterilised by the acid was placed over the lint, to prevent the antiseptic from evaporating. This was fixed with adhesive plaster and packing was used between the limb and the splints to soak up blood or discharges during 1 or 2 days. A crust formed consisting of blood and the acid that was not removed except to apply a new antiseptic. Once a day, the cap was removed and the crust painted with carbolic acid. Lister tried to ensure the crust didn't become sceptic and at the same time was looking for the surface closest to the wound to experience effluxion of the phenol, resulting in the wound healing. He was essentially seeking "healing by scabbing" without suppuration.

While the treatment possessed many of the essential characteristics of the antiseptic dressings that Lister would subsequently introduce, it failed and suppuration began to occur, leading to the death of the patient. Lister blamed himself and noted that the treatment "..proved unsuccessful, in consequence, as I now believe, of improper management".

The essential part of the wound treatment was not the application of strong carbolic acid to the wound, although that required careful management to ensure the wound was sterilised, but designing the dressing in such a manner to stop the ingress of airborne infection. This was often misunderstood, even when he was explaining the procedure to fellow doctors at Glasgow who were celebrating him as humanity's benefactor, and it caused him considerable irritation and unhappiness later in life. They were confused by the initial application of the acid and this led to the claim that Lister was advocating for the use of carbolic acid to prevent suppuration.

Elaboration of the antiseptic treatment (1866-1869)

In July 1866, while he continued to treat compound fracture cases, he applied for a vacant surgeoncy position at the University College London. It was an attractive position as it came with guaranteed post at University College Hospital. He approached Lord Henry Brougham to prepare a testimonial that included a short description of the antiseptic system, which was the first formal description of his work. However, he lost the election. Lister was confident in achieving the position. In a letter to his father on 6 August 1866 he described "The disappointment was at first extremely severe : more so than I had expected". The position went to John Marshall who had been an assistant surgeon for some 18 years.

In early 1867, Lister began writing the compound fracture case histories of his experiments with carbolic acid in a series of papers, the first to describe his new technique of antiseptics. Titled On a New Method of treating Compound Fracture, Abscess, Etc., with Observations on the Conditions of Suppuration. the paper was published in The Lancet in five instalments with the first appearing on 10 March 1867. and the last part on abscesses added in July 1867. The paper was divided into a main section dealing with compound fractures, and a short note on the treatment of abscesses.

Lister's theory of inflammation provided the conceptual structure of the article. He stated that the inflammation that appeared immediately after an injury was both necessary and dangerous. It was a precursor to healing, but the fluids which flowed into the wound were akin to dead tissue. Inflammation could trigger putrefaction. Lister described tissues healing by granulation, which he believed was the likely outcome in wounds in compound fractures. Lister believed that cells of granulated tissue were remarkably active and that since they were alive, they were immune to putrefaction and also to secondary inflammation, as they lacked sensory nerves. Airborne putrefaction, "a danger that was underrated", was proven by the scabs which appeared to protect small wounds as they healed. Lister then explained how often it appeared in less than 24 hours and had an associated smell. He described the source of putrefaction and how the "raw surface" of the wound could putrify before the granulations formed or the liquids on the surface of the granulations putrified. The liquids were extremely acrid and acted on the sensory nerves to initiate indirect inflammation and fever. This led to increased cell turnover and cellular death, increasing the quantity of putrescent material in the wound. Sloughs were produced that resulted in suppuration.

First reception of antisepsis (1867-1868)

Although Lister was honoured in later life, his ideas about the transmission of infection and the use of antiseptics were widely criticised in his early career. On 24 August 1867, within a month of Lister's publishing his first paper on antiseptics, the editor of The Lancet, Lister's nemesis James G. Wakley, wrote an editorial crediting Pasteur for Lister's research and invited physicians to investigate Lister's claims and report their findings to the journal.

On 21 September 1867, Scottish obstetrician James Young Simpson, professor of medicine and midwifery at Edinburgh University and discoverer of chloroform, published an editorial that attacked Lister in the Edinburgh Daily Review, written under the pen name "Chirurgicus", a common practice to signal a personal attack. Simpson's motive was that he was trying to convince the medical community of the efficacy of his acupressure technique, which used needles to halt arterial haemorrhage, counter to Lister's use of ligatures. The editorial letter was the first of many and began a tit-for-tat argument in the press over months and eventually led to the acceptance of antisepsis.

Simpson claimed that Lister's prior article had copied a continental practice and accused him of plagiarising the work of French doctor and pharmacist Jules Lemaire. Lemaire had described carbolic acid as a constituent of coal tar in 1860 in "Saponinated coal tar" and after a long series of investigations had followed up with an 1863 book, De l'acide phénique, de son action sur les végétaux, les animaux, les ferments, les venins, les virus, les miasmes et de ses applications à l'industrie, à l'hygiène, aux sciences anatomiques et à la thérapeutique ("Carbolic acid, its action on plants, animals, ferments, venoms, viruses, miasmas and its applications to industry, hygiene, anatomical sciences and therapy") with the second edition in 1865, where he described the antiseptic power of carbolic acid. While Lemaire believed in the germ theory and realised the causes of putrefaction, he made no attempt to develop a process to exclude them from the wound.

On 5 October 1867, Lister gave a robust reply to Simpson in a letter "On the Use of Carbolic Acid" to The Lancet, denying that he had heard of Lemaire's work and arguing that that work had made little impact on the medical profession. Lister went on to defend his work, stating:

The catgut ligature (1867-1869)

A practical problem in general surgery that Lister researched and developed was absorbable ligatures that were used to tie large blood vessels during amputation. It had been known for years that gunshot bullets, i.e. smooth metallic objects, could remain inside the body without causing suppuration but suppuration would occur in silk or thread ligatures, which resulted in the ends being left outside the body to enable the ligatures' removal. However, that method left an open path for germs to enter the body alongside the ligating material, and presented a risk of secondary hemorrhage when the ligatures were removed. By late 1867, he understood that ligatures were sources of irritation. Lister also noticed, while treating a patient with a compound fracture, how a piece of dead bone had become live bone again as new blood vessels suffused the fracture. He reasoned that it was possible to find a material that could be absorbed into the body, thereby reducing the ingress of germs. He initially took the standard silk thread and impregnated it with carbolic acid. On 12 December 1867, in the first of a series of experiments, Lister tested the new ligature by tying the carotid artery of a horse. When the horse died six weeks later (of natural causes) it was dissected, and he found dense fibrous tissue had grown over the ligature. But he noticed the silk was being absorbed rather slowly.

On 2 February 1868, in a letter to his father he reported using the new ligature on a private patient with a leg aneurysm. The patient recovered completely. On 5 February he expressed his profound excitement at the patient's recovery to his father. However, the lady died 10 months later of another aneurysm due to vascular disease. During the dissection, Lister found that most of the ligature had been absorbed but found a tiny blob of thick pus on the remaining piece, that led him to think an abscess could have formed. He began looking for another material and settled on catgut. On 31 December 1868, while staying at Upton for Christmas, Lister tested the new carbolised catgut on a calf, running the experiment in his father's museum. He again tied the carotid artery and after a month, the calf was dissected. Initially he thought the ligature was still in-situ, but on closer examination saw that living tissue was growing into the structure. In a letter to his father he described his findings :

I know thee will be anxious to know what I have found in the calf's neck. Well, at first on dissecting down on the artery I was much disappointed to see that the ligatures were still there, as large as ever. But on attempting to isolate them from surrounding parts, I found them inseparably blended with the coats of the artery. And further examination confirmed the conclusion that the substance of the ligatures had been replaced by living tissue, differing in character altogether from that of the gut; being fibrous tissue in process of formation, not perfect tissue like that of the gut or peritoneum."

Visitors to Glasgow

Beginning in the spring of 1868, Lister had several more visitors in Glasgow. These included Joseph Bell, a former student of Lister and William MacCormac. In June 1868 Marcus Beck visited Lister and was invited to attended lectures given by Lister on operative surgery. In a letter to his father in July 1868, he describes how Beck was horrified when Lister made a free incision into a patients knee joint to repair loose cartilage.

During this period Lister read several reports in 'The Lancet on the successful use of his technique. One in July 1868 was from Pearson Robert Cresswell (1834–1905), chief surgeon to the Dowlais Ironworks in Merthyr Tydfil. Cresswell reported successfully treating a man who had been shot in the leg. He described the new technique as "quite a revolution". In August, the lecture series ended and the couple went on holiday to Ventnor on the Isle of Wight.

Reception at home

On 5 September 1868, Wakley, who was aware of the report, wondered why London hospitals had not adopted antiseptics and posted a sarcastic enquiry on : "Are the conditions of suppuration different here from those in Glasgow or Dowlais? Or is it that the antiseptic treatment is not tried with that care without which Mr. Lister has always pointed out it does not succeed?". Over the next several months Wakley published a series of brief reports from London surgeons. The first to report were St George's Hospital surgeons, who followed Lister's directions exactly on 26 cases of lacerations but only 7 healed correctly and none by first intention healing. They described how little they understood antiseptics. In November 1868, Thomas William Nunn of Middlesex Hospital had some initial success but other surgeons offered differing opinions to its efficacy of the technique and described the acid as one of several disenfectants that could be used to dress wounds. The surgeons at Guys and St Bartholomew's Hospital had a similar experience. On 5 December 1868, the prominent pathologist James Paget of St Bartholomew's Hospital reported that he found the acid "useless" but admitted he might have been applying the technique incorrectly. Thomas Bryant, the chief surgeon at Guy's Hospital felt the technique worked as had John Wood at King's College Hospital who experimented with many different antiseptic compounds. There was also positive news when The Prince of Wales's General Hospital in Tottenham reported that it was using the full antiseptic system and had no pyaemia or erysipelas cases but one surgeon John Marshall refused the treatment due to a patients "green urine and other toxic symptoms".

In July 1869, at the annual conference of the British Medical Association (BMA) at Leeds, attended by both Simpson and Bennett, the English surgeon Thomas Nunneley mocked Lister's ideas on antisepsis and expressed disbelief in the germ-theory of wound infections. Nunneley was a well respected researcher and expert on erysipelas who proudly boasted during the surgical address that he had not permitted a single patient to be treated by carbolic acid during the three years that his colleagues had used it and achieved no better results than him. He labeled antiseptic treatment as both "fashionable" and "in vogue", based on "unsupported fancies which have little other existence than what is found in the imagination of those who believe in them".

However it was his attack on Lister central premise of the germ theory that was so useful to Lister's detractors; that first intention healing occurred in wounds that were exposed to the air. In his conclusion he stated:

Edinburgh appointment

In April 1869, Syme had a paralytic seizure that he only partially recovered from and was eventually forced to resign his chair during the summer. At the time, Listers 10-year appointment at Glasgow was coming to an end, making him a natural candidate to replace Syme, who supported Lister candidacy. On 5 July 1869, Lister received a letter from 127 Edinburgh medical students, who believed he was the best candidate for the position and urged Lister to apply:

We take this step from a conviction that you are the man most capable, from your high attainments and achievements in Surgery, to maintain the dignity and renown which have been conferred upon the Chair and the University by Mr. Syme

Lister decided to only use a few testimonials believing quality mattered more than quantity. So he selected Paget, Erichsen, Sharpey, the Manchester surgeon Edward Lund (1823 - 1898), the Principal of Edinburgh University Thomas Barclay and the Liverpool surgeon Edward Robert Bickersteth (1828 - 1908). On 18 August 1869, Lister was elected to the chair of clinical surgery at Edinburgh University. He left Glasgow University in October 1869 and was succeeded by Scottish surgeon George Husband Baird MacLeod.

Edinburgh 1869–1877

Fathers death

Within a month of Lister's Edinburgh appointment, his father who was 84 became seriously ill. He had been planning a visit to Upton the following week and had written a letter on 12 September, that unbeknownst to him, was his last letter to his father. When his father took a turn for the worse, he rushed south to spend the last few days with him. Joseph Jackson Lister died on 24 October 1869. When the family belongings were split up, many of the books went to Lister. The house at Upton was sold in January 1870.

In October 1869, the Listers moved across to Edinburgh, first staying at a furnished house at 7 Abercromby Place.

Address

On 8 November 1869, Lister held his first introductory lecture at Edinburgh medical school, "An introductory Lecture (On the Causation of Putrefaction and Fermentation)" where he elaborated on the nature of germs, as a rebuttal of Bennett's theory. Lister opened the lecture by paying tribute to his mentor, Syme, then told his students the importance of clinical practice. Then he turned to an examination of the germ theory, the scientific method and then explained the reasons for the comprehensive rejection of the theory of spontaneous generation, introduced his flasks and described how they proved the germ theory.

Listers most quoted paper

On 1 January 1870, Lister published "On the Effects of the Antiseptic System of Treatment upon the Salubrity of a Surgical Hospital". This was the paper where Lister described the pit burials in the old cathedral churchyard next to the GRI and the many graves from the cholera epidemic of 1849. These coffins were stacked underground inches below the surface and only separated from Lister's male ward by a 3-foot basement. He described how his wards had undergone a "striking change", "converting them from some of the most unhealthy in the kingdom into models of healthiness". Considered one of his most quoted papers, its purpose was to show if the antiseptic treatment was correctly applied, it would reduce the mortality rate after amputation in even the most unhealthy wards. He compared operative death rates for amputation over a 5-year period, between 1867 and 1869 to the two years between 1864 and 1866. The results showed that 16 of 35 patients died in the first period compared to 6 deaths in 40 for the second period, after the antiseptic treatment was introduced. Of 32 cases of compound fracture, none had contracted pyaemia and between that period only 2 deaths from pyaemia occurred, 1 from erysipelas and in 1869, 1 from gangrene. This was particularly impressive, considering Lister's wards were only separated from the other accident male word on the ground-floor of the GRI by a short corridor. That ward had been closed down in 1867 due to an outbreak of disease.

After the death of his father, Lister's writing was no longer tempered by his advice resulting in the paper exhibiting a lack of tact, boastfulness, and level of conceit not seen in his previous papers. After attacking the hospital administrator for not cleaning his wards over a 3-year period, he recalled from a meeting in the early 1860s:

At this period I was engaged in a perpetual contest with the managing body, who, anxious to provide hospital accommodation for the increasing population of Glasgow. For which the Infirmary was by no means adequate, were disposed to introduce additional beds beyond those contemplated in the original construction. It is I believe, a fairly attributable to the firmness of my resistance in this matter that, though my patients suffered from evils alluded to in a way that was sickening and often heart-rending... yet none of my wards ever assumed the frightful conditions which sometimes show itself in other parts of the building, making it necessary to shut them up entirely for a time.

On the 15 January, Wakely in The Lancet called for the London surgeons to "fairly and crucially" test the antiseptic treatment. Wakely also commented on hospitalism, i.e. the idea that hospitals themselves were gateways to death resulted in Simpson starting a campaign to destroy certain large hospitals.

Improved protective

After a series of experiments between 5 July-25 October 1871 he finally settled on oiled-silk coated on each side with gum copal that was then painted with a coating of dextrine, which enabled it to be wetted. The plaster was then soaked in carbolic acid which was allowed to evaporate. The resulting plaster was much more effective in protecting the wound against the antiseptic dressing.

Lister's meticulous nature became ever more apparent in his casebooks for wards 4 and 5 at the infirmary.

On 14 January 1871, Lister published his first details of '"Gauze and Spray" in the British Medical Journal.

Sprays

Therefore, Lister tested the results of spraying instruments, surgical incisions, and dressings with a solution of carbolic acid. Lister found that the solution swabbed on wounds remarkably reduced the incidence of gangrene.

Again, in 1873, the medical journal The Lancet warned the entire medical profession against his progressive ideas. However, Lister did have some supporters, including Marcus Beck, a consultant surgeon at University College Hospital, who practised Lister's antiseptic technique and also included it in the next edition of one of the main surgical textbooks of the time.

London 1877–1900

On 10 February 1877, the Scottish surgeon Sir William Fergusson, Chair of Systematic Surgery at King's College Hospital, died. On 18 February, in reply to a tentative approach from a representative of Kings College, Lister stated that he would be willing to accept the chair if he could radically reform the teaching there. There was no doubt that Lister's mission was both evangelical and apostolic and this was his true purpose in moving to London.

British surgeon John Wood, who originally next in line, was elected to the chair. Wood was hostile to Lister obtaining the chair. On 8 March 1877, in a private letter to an associate, Lister contrasted their differing teaching methods and stated in no uncertain terms his opinion of Fergusson, "The mere fact of Fergusson having held the clinical chair is surely a matter of no great moment". In a comment to another colleague, Lister stated that his goal in taking the appointment was "the thorough working of the antiseptic system with a view to its diffusion in the Metropolis". At a memorial held by his students to persuade him to remain, Lister criticised London teaching. His impromptu speech was heard by a reporter who ensured that it was published in the London and Edinburgh newspapers. This jeopardised Lister's position, as word reached the governing council at King's College, who awarded the chair to John Wood a few weeks later.

However, negotiations were renewed in May and he was finally elected on 18 June 1877 to a newly created Chair of Clinical Surgery. The second Clinical Surgery Chair was created specifically for Lister because the hospital feared the negative publicity that would have resulted had Lister not been elected. Lister remained at King's College Hospital for sixteen years before retiring in 1893 following the death of his wife.

Moving to Regents Park

On 11 September 1877, Joseph and Aggie moved to London and found a John Nash designed house at 12 Park Crescent in Regent's Park. Lister began teaching on 1 October. The hospital made attendance at Lister's lectures mandatory for all students. Attendance was small, compared to the four hundred students who regularly attended his classes in Edinburgh. Lister's conditions of employment were met, but he was only provided with 24 beds, instead of the 60 beds that he was used to in Edinburgh. Lister stipulated that he should be able to bring from Edinburgh four people who would constitute the core of his new staff at the hospital. These were Watson Cheyne, who became his assistant surgeon, John Stewart, an anatomical artist and senior assistant, and W. H. Dobie and James Altham, Lister's dressers (surgical assistants who dressed wounds). There was considerable friction at Lister's first lecture, both from students who heckled him and staff. Even the nurses were hostile. This was clearly illustrated in October 1877 when a patient, Lizzie Thomas, who travelled from the Edinburgh Royal Infirmary to be treated for a Psoas abscess, was not admitted due to not having the correct paperwork. Lister could hardly believe that such a lack of sympathy from imperious nurses could exist. More so, such a state of mind was a real danger to his patients, because his system depended on loyal staff to carry out the preparations for antiseptic surgery.

Introductory address

On 1 October 1877, Lister held the customary introductory address. His inaugural lecture in London concerned "The nature of fermentation". Lister described the fermentation of milk and explained how putrefaction was caused by fermentation of blood and tried to prove that all fermentation was due to microorganisms. This was the first time since 1871 that Lister described his support for the theory that living germs caused disease. To demonstrate, he used a series of test tubes containing milk, loosely covered with glass caps. Although air had entered the test tubes and the milk had not decomposed, demonstrating that air was responsible for fermentation. The experiment had two conclusions, first that unboiled milk had no tendency to ferment and secondly that an organism that Lister had isolated, Bacterium lactis was the cause of lactic acid fermentation.

The address was badly received. St Clair Thomson, who entered King's College Hospital as a first-year student on the same day and attended this lecture, later recalled, that Lister's lecture on fermentation was received with indifference. In defence, John Stewart described it as: "a brilliant and most hopeful beginning of what we regarded as a campaign in the enemy's country... There seemed to be a colossal apathy, an inconceivable indifference to the light which, to our minds, shone so brightly, a monstrous inertia to the force of new ideas."

Wiring of fractured patellas

In October 1877, Lister performed an operation on a patient, Francis Smith, that was not considered life-threatening. The open operation on a fractured patella, in front of 200 students, involved wiring the two fragments together and was likely the first time a healthy knee-joint was ever opened.

In October 1883, St Clair Thomson gathered together and examined Lister's first seven knee surgery patients at the Medical Society of London meeting.

Reception abroad (1870–1876)

In 1869, Mathias Saxtorph from the University of Copenhagen visited Lister in Glasgow to adopt his methods. In July 1870, Saxtorph recognised Lister's technique as being effective in a letter to Lister where he stated:

The Frederick Hospital, to which I am head surgeon is a very old building and I have 150 patients in the surgical wards. Foremerly, there used to be every year several cases of death from pyaemia, sometime, arising from the most trivial injuries. Now, I have had the satisfaction that not a single case of pyaemia has occurred since I came home last year, which result is certainly owing to the introduction of your antiseptic treatment.

Germany

The first use of Lister's method in Germany was by Karl Thiersch in Leipzig in 1867. Thiersch practised Lister's approach since its introduction and never published his results, but did teach it to his students. His house surgeon Hermann Georg Joseph tested it on 16 patients with abscesses, with favourable results. Joseph wrote a thesis on his results, proving the value of the Lister method, and presented in Leipzig the following year. In January 1870, Heinrich Adolf von Bardeleben presented a paper to the Berlin Medical Society that described the results but provided no statistical evaluation of them.

The adoption of Listerism on the European continent halted during the Franco-Prussian War, but it became the greatest opportunity to advance Lister's ideas. At the start of the war, Lister had written a pamphlet known as "A Method of Antiseptic Treatment Applicable To Wounded Soldiers in the Present War" that described a simplified technique of antiseptic that could be used on the battlefield and military hospital. The pamphlet was immediately translated into German, but never made a material difference.

By far the most important advocate for Lister's antiseptic system in Germany was surgeon and osteotomy specialist Richard von Volkmann, who taught at the University of Halle. In August 1870, he became surgeon-general during the Franco-Prussian War and was responsible for 12 army hospitals and 1442 beds. When he returned to his own hospital in the winter of 1871, he found large numbers of patients with infectious diseases throughout the ward. He wrote of the experience:

The mortality after large amputations and complicated fractures grew year by year. In the summer of 1871, during my absence on the battlefield, the clinic was crowded by a large amount of injured. For eight months, in the winter of 1871 to 1872, the numbers of blood poisoning and rose disease victims were so great, that I considered applying for a temporary closure of the facility. Without a morgue, the dead stayed in the cellar beneath the wards

In 1872, Volkmann sent his assistant Max Schede to visit Lister at his clinic, to learn his new techniques. Once Schede returned in the autumn of 1872, Volkmann began to use Lister's new techniques. On 16 February 1873, in a letter to Theodor Billroth, Volkmann wrote:

Later life

In December 1892, Lister attended a celebration of the 70th birthday of Pasteur at the Sorbonne in Paris, The theatre, designed to hold 2,500 people, was crowded. The audience included the university governing staff, ministers of state, ambassadors, President of France Sadi Carnot, and representatives from the Institut de France. Lister, invited to give the address, received a great ovation when he stood up. He spoke of the debt that he and surgery owed to Pasteur. In a scene captured later by Jean-André Rixens, Pasteur strode forward and kissed Lister on both cheeks. In January 1896, Lister was present when Pasteur's body was laid in his tomb at the Pasteur Institute.

In 1893, four days into a spring holiday in Rapallo, Agnes Lister died from acute pneumonia. While still responsible for the wards at King's College Hospital, Lister's private practice ceased along with an appetite for experimental work. He severely curtailed social gatherings, studying and writing lost appeal for him, and he sank into religious melancholy. Lister retired from King's College Hospital in 1893. Lister was presented with a portrait painted by Scottish artist John Henry Lorimer, in a small presentation, held in recognition of the affection and esteem that felt by his colleagues.

Despite suffering a stroke, he still came into the public light from time to time. He had for several years been a Surgeon Extraordinary to Queen Victoria, and from March 1900 was appointed the Serjeant Surgeon to the Queen, thus becoming the senior surgeon in the Medical Household of the Royal Household of the sovereign. After her death the following year, he was re-appointed as such to her successor, King Edward VII.

In 1902, King Edward developed appendicitis just before his scheduled coronation. By 24 June, two days before the ceremony, he had a 10-day history of symptoms including with a distinct mass on the right lower quadrant. Edward was operated on by Sir Frederick Treves. Like all internal surgery at the time, appendectomy still posed an extremely high risk of death by post-operational infection, and Treves did not dare operate on the King without consulting Britain's leading surgical authority. Lister obligingly advised on the latest antiseptic surgical methods (which were followed to the letter). The King survived, later telling Lister, "I know that if it had not been for you and your work, I wouldn't be sitting here today."

Death

Lord Lister died on 10 February 1912 at his country home at the age of 84. The first part of Lister's funeral was a large public service held at Westminster Abbey, which took place at 1.30 p.m. on 16 February 1912. His body was moved from his house and taken to the Chapel of St. Faith and a wreath of orchids and lilies was placed by the German ambassador Count Paul Wolff Metternich on behalf of the German Emperor Wilhelm II. Before the start of the service, Frederick Bridge played the music of Henry Purcell, the funeral march by Chopin and Beethoven's Tres Aequili. The body was then placed on a high catafalque, where his Order of Merit, Prussian Pour le Mérite, and Grand Cross of the Order of the Dannebrog were placed. It was then borne by several pallbearers including John William Strutt, Archibald Primrose, Rupert Guinness, Archibald Geikie, Donald MacAlister, Watson Cheyne, Godlee, and Francis Mitchell Caird to a hearse, which conveyed the catafalque to Hampstead Cemetery in London, reaching it at 4 p.m. Lister's body was then buried in a plot in the south-east corner of the central chapel, attended by a small group of his family and friends. Many tributes from learned societies all over the world were published in The Times on that day. A memorial service was held in St Giles' Cathedral in Edinburgh on the same day. Glasgow University held a memorial service in Bute Hall on 15 February 1912.

A marble medallion of Lister was placed in the north transept of Westminster Abbey, which sits alongside four other noted men of science, Darwin, Stokes, Adams, and Watt.

Lister Memorial Fund

Following his death, the Lord Lister Memorial Fund was established by the Royal Society as a public subscription to raise monies for the public good in honour of Lord Lister. It led to the founding of the Lister Medal, considered the most prestigious prize that can be awarded to a surgeon.

Awards and honours

On 26 December 1883, Queen Victoria created Lister a baronet, of Park Crescent in the parish of St Marylebone in the county of Middlesex.

In 1885, he was awarded the Pour le Mérite, the highest Prussian order of merit. The order was restricted to 30 living Germans and as many foreigners.

On 8 February 1897, he was further honoured when Her Majesty raised him to the peerage as Baron Lister, of Lyme Regis in the county of Dorset.

In the 1902 Coronation Honours list published on 26 June 1902 (the original day of King Edward VII's coronation), Lord Lister was appointed a privy counsellor and one of the original members of the new Order of Merit (OM). He received the order from the King on 8 August 1902, and was sworn a member of the Privy Council at Buckingham Palace on 11 August 1902. In December 1902, the King of Denmark bestowed upon Lister the Knight of the Grand Cross of the Order of the Dannebrog, an Order of chivalry that gave him more pleasure than any of his later honours.

Medals

Throughout his life, Lister was awarded a number of medals for his achievements.

In May 1890, Lister was awarded the Cameron Prize for Therapeutics of the University of Edinburgh, that included the delivery of a short oration or lecture, that was held at the Synod Hall in Edinburgh. In November 1902, Lister was awarded the Copley Medal by the Royal Society "for sustained, outstanding achievements in any field of science".

Academic societies

Lister was a member of the Royal College of Surgeons of England between 1880 and 1888.

In 1877, Lister was awarded the Cothenius Medal of the German Society of Naturalists. In 1886, he was elected vice president of the college, but declined the nomination for office of president, as he wished to devote his remaining time to further research. In 1887, Lister presented the Bradshaw lecture with a lecture titled "On the Present Position of Antiseptic Treatment in Surgery". In 1897, Lister was awarded the College Gold Medal, their highest honour.

Lister was elected to the Royal Society in 1860. He served as a trustee on the Royal Society council between 1881 and 1883. Ten years later, in November 1893 Lister was elected for two years, to the position of foreign secretary of the society, succeeding the Scottish geologist Sir Archibald Geikie. In 1895, he was elected president of the Royal Society succeeding Lord Kelvin. He held the position until 1900.

In March 1893, Lister received a telegram from Pasteur, Félix Guyon and Charles Bouchard that informed him he had been elected an associate of the Académie des Sciences.

Lister was elected an International Honorary Member of the American Academy of Arts and Sciences in 1893, an International Member of the American Philosophical Society in 1897, and an International Member of the United States National Academy of Sciences.

Monuments and legacy

In 1903, the British Institute of Preventive Medicine was renamed Lister Institute of Preventive Medicine in honour of Lister. The building, along with another adjacent building, forms what is now the Lister Hospital in Chelsea, which opened in 1985. The building at Glasgow Royal Infirmary which houses the cytopathology, microbiology, and pathology departments was named in Lister's honour to recognise his work at the hospital. The Lister Hospital in Stevenage, Hertfordshire is named after him.

Lister's name is one of 23 people featured on the frieze of the London School of Hygiene & Tropical Medicine – although the committee which chose the names to include on the frieze did not provide documentation about why certain names were chosen and others were not.

Only two British surgeons have public monuments in London, Lister and John Hunter. The statue of Lister, created by Thomas Brock in bronze in 1924, stands at the north end of Portland Place. A bronze statue of Lister, mounted on a granite base in Glasgow's Kelvingrove Park, was sculpted by George Henry Paulin in 1924. It sits next to a statue of Lord Kelvin.

The Discovery Expedition of 1901–1904 named the highest point in the Royal Society Range, Antarctica, Mount Lister.

In 1879 Joseph Lawrence, the American inventor of Listerine antiseptic, developed as a surgical antiseptic but nowadays best known as a mouthwash, named it after Lister.

Microorganisms named in his honour include the pathogenic Listeria bacterial genus named by J. H. H. Pirie, typified by the food-borne pathogen Listeria monocytogenes, and Listerella slime mould genus first described by Eduard Adolf Wilhelm Jahn in 1906.

Two postage stamps were issued in September 1965 to honour Lister on the centenary of his antiseptic surgery at the Glasgow Royal Infirmary of Greenlees, the first ever recorded instance of such treatment.

Reference volumes

The following three books are the earliest reference volumes on the antiseptic surgery:

Ernest SA (1871). The antiseptic system : a treatise on carbolic acid and its compounds : with enquiries into the germ theories of fermentation, putrefaction, and infection; the theory and practice of disinfection; and the practical applications of antiseptics, especially in medicine and surgery. London: Henry Gillman.

MacCormac W (1880). Antiseptic surgery : an address delivered at St. Thomas's Hospital : with the subsequent debate to which are added a short statement of the theory of the antiseptic method, a description of the materials employed in carrying it out, and some applications of the method to operations and injuries in different regions of the body, and to wounds received in war. London: Smith, Elder and Co. pp. 100–283. OCLC 956538596.

Cheyne WW (1882). Antiseptic surgery : its principles, practice, history and results. London: Smith, Elder and Co. OCLC 14790004.