Sir Joseph Lister

1827-1912

British Surgeon

Joseph Lister is recognized as the father of antiseptic surgery. His insistence that a surgeon must protect the wound against outside organisms is one of the fundamental guiding principles of modern surgery.

Lister was born April 5, 1827, in Upton, Essex, England. His parents, Joseph Jackson and Isabella Harris Lister, took a great interest in their son's education. They instructed him and sent him to Quaker schools that emphasized natural history and science. At age 16 he decided medicine would be his career.

Lister graduated from King's College, London, and became a house surgeon at University Hospital in 1852. Edinburgh, Scotland, was recognized as an ancient medical center, and Lister was appointed as assistant to James Symes, the best surgeon of the day. He later married Symes's daughter. Lister received an appointment to the Edinburgh Infirmary in 1856, and later to the new Glasgow Royal Infirmary in 1861. As a surgeon Lister was concerned that over half of the patients who underwent amputations died. He noted that simple bone fractures, which had unbroken skin, almost always healed without any problems; however, compound fractures, in which the broken bone punctured through the skin and was exposed, often resulted in hospital gangrene or other infections that caused the patient to die.

In the 1860s little was known about microbes and the causes of infection. Explanations ranged from miasma, or bad air, to the explosion of tissue when exposed to air. Lister read Pasteur's studies of airborne microbes and was convinced that it was not the air itself, but organisms from the air. Louis Pasteur (1822-1895) used heat to kill microbes, but since this would not be practical in an operating room, he began to search for a chemical to use. He read about how carbolic acid (phenol) had been used to purify sewage at Carlisle, England, and hit upon the idea of using this compound in the operating room.

On August 12, 1865, Lister performed a historic operation that ushered in a new era of surgery. An eleven-year-old boy named James Greenlees was run over by the wheel of a wagon and had a compound fracture. Lister applied carbolic acid to the wound, dressed, and splinted it carefully. Six weeks after surgery James walked out into the world and into surgical history. Not only did Lister put the phenol solution on wounds, he soaked instruments and anything coming into contract with the wound. He even developed a carbolic-acid atomizer to spray the room, an idea he later discarded. Another contribution to surgery was the use of strong, antiseptic septic catgut ligatures that were stored in carbolic acid.

In 1867 Lister published a series of cases showing how surgical mortality fell dramatically in his Male Accident Ward. In 1869 Lister became head of clinical surgery at Edinburgh and the happiest years of his life followed. The Germans had experimented with antisepsis during the Franco-Prussian War and his clinics were packed with visitors and students. He was invited to lecture at prominent centers in Germany.

Lister's work was not appreciated in the United States and England where opposition to the germ theory remained steadfast. However, in 1877 Lister was offered a position at King's College, London, and again the opportunity to make surgical history. At that time the standard procedure for treating a fractured patella involved forcing the simple fracture into a compound fracture, often resulting in death from infection. Lister performed a spectacularly successful and widely publicized procedure whereby he wired the patella using antisepsis. This operation marked a turning point in the acceptance of germ theory and antisepsis among physicians.

Lister enjoyed a privilege denied many scientific innovators; he saw his principles accepted during his lifetime and was honored with the title of baronet in 1883. He was also appointed as one of the twelve original members of the Order of Merit in 1902. The Lister Institute of Preventive Medicine was founded in 1891.

Lister was a humble, religious, and unassuming man, uninterested in financial gain or fame. After the death of his wife in 1893, he retired from surgery and, at his death in 1912, was almost completely blind and deaf.

EVELYN B. KELLY