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tion them because Lister suffered more than tion, and I can remember the surprised any other member of the staff from their and approving sniff with which the visitorpetty restrictions, their frigid rules, and generally a foreigner-confirmed Lister's their repressive formality. They made them- frequent and pleased remark: "You will selves particularly obnoxious to Lister, as note, gentlemen, that the discharge is he gave more work than any other surgeon; serous and quite sweet.” he visited his wards daily, instead of twice Yet Londoners did not come to see this a week; he had the boldness to show himself revolutionary change, to hear, to smell, , at the Hospital after dinner, or even on a and to be converted. Sunday if a case gave him any anxiety; also In Edinburgh his class frequently numthe technique of his dressings involved bered four hundred students; in London much washing-up and the spreading of some ten to twenty might turn up, but mackintoshes to limit the effects of the these gradually fell off. I have heard a careclouds of watery carbolic spray in which we fully prepared, thoughtful, philosophic lecthen worked. At least two hours daily were ture, one which helped to lay the very fountaken up by dressings, which Lister insisted dation of a physiological understanding of on carrying out himself or seeing carried our work, delivered by Lister to half a out under his own eye; there was much up- dozen men, and many a time I have seen set in the wards by his having patients him at work in theatre or ward, accomcarried or wheeled into the operating theatre panied only by his own suite. When comfor his regular clinical demonstrations; in pleted, this consisted of six dressers, three fact, he upset these pious ladies by disturb- clerks (who must all have previously served ing the atmosphere they had created, as dressers) and his house-surgeon. Each which clearly suggested that medical men office lasted for six months. It was only the were allowed on sufferance in a hospital to enthusiasts, or those who had some inkling do an operation or write a prescription, that they were serving a great master, who but that it was the nursing which took cared to give six to eighteen months to first place, and that the all-important receiving this precious instruction in the points were that the bed should be stiffly science and principles of surgery. The rest tidy, the patient's face shinily clean, and cared for none of these things, they were that he should say his prayers!
indifferent, they were utilitarians, who, Worse than these two cold douches was with what the world might in its foolishness what John Stewart describes as the colossal call “shrewd common sense,” saw that apathy, the inconceivable indifference, Lister's teaching was no use to them, for shown by the students and surgeons of he did not coach them in the subjects London. The wards of most of the hospitals required for examination, nor hand round in England at that time stank with the the tips which were to get the student hospital air of putrefaction. I remember the through. Lister noticed that though the tin tray placed below an amputated stump London student has an affection for his to catch the dripping pus, and the frequency school, he has none for the University of with which in the postmortem room we London where he graduates, or for the saw the amyloid degeneration which indi- Royal Colleges where he takes his diploma, cated the patient's long and weary passage and hardly any for the city in which he to the grave with hectic and surgical fever. studies. The Scotch student has more Lister's wards were sweet; his dressings, esprit de corps and more feu sacré in following when taken off, were free from putrefactive a teacher or getting to the root of a odor; they were handed round for confirma- subject. (Strange that we have to employ French words to explain these un-English indeed, I remember a time when the stutraits!)
dents complained of this and also of the The English student is keener on securing fact that not infrequently Lister gave half a diploma with which to earn his living. his lecture in French or German, for he But is he entirely to blame for this? In could make an extempore speech quite London much is sacrificed to the examina- easily in either language. This complaint tion system, which encourages cramming, came round to Lister's ears, and I remember stifles any spirit of inquiry or love of how he took the opportunity of a quiet day knowledge for its own sake, and compels to refer to it, saying that if the students the teacher to limit his instruction to pre- showed as much enthusiasm as the foreign paring the student to pass, not only certain visitors he would see to it that they were examinations, but certain examiners. The not ousted from the best seats. Like all his complete separation of teacher from exam- little corrections, this was said most couriner also handicaps the student. It is not teously and more in sorrow than in anger. the student who is to blame; it is our faulty Among the visitors from overseas we methods of teaching and examination. Ten made many interesting acquaintances. I
. years later Lister referred to his small remember an American surgeon turning classes at King's, after his crowded audi- up one day who told me he had been to ences at Edinburgh, as "a humiliating Vienna to see Billroth, but he did not conexperience.”
sider him equal to a “bully operator" they But, if students and London surgeons had in Buffalo, from which the visitor came. were apathetic and short-sighted over the He arrived at the hospital on Saturday revolution being wrought in surgery, it was just before lunch, and I told him Lister not so with the foreigners. In the entrance not expected till two o'clock. He hall of the old Hospital there was a notice said he would wait, and asked if he could board forbidding smoking in English, not look around the hospital in the meanFrench and German, thus:
time. I had the happy thought of turn
ing him over to the secretary, whom he Smoking forbidden
dragged all over the building and reduced Il est défendu de fumer Das Rauchen ist verboten.
to a limp mass before two o'clock.
When the master arrived promptly, our In later years many must have wondered visitor said, “Professor Lister, Sir, I am told when the necessity had occurred for this your wounds heal without suppuration, polyglot announcement, for it was rare for and I've come all the way from Buffalo to any Frenchman or German to find his way see them.” The ever courteous professor there, and if he did, he was so solitary and said he was sorry, but that no cases required felt so much the repressive atmosphere of dressing that day; that the next day was a our misty island, that he would hardly Sunday, and as he had no class he would be have had the hardihood to light an innocent changing the dressings in the morning. cigarette. But it was different in the The irrepressible visitor said, “No matter, eighties. When I was Lister's house-surgeon I'll be there.” And there he certainly was, in 1883, foreigners poured in from the ends on the Sunday morning. When all had been of the earth, crowded the entrance hall, shown him he exclaimed, “Sir, I was like and there, while waiting for the master, the doubting Thomas in the Scriptures, they would make the air thick with tobacco I would not believe without seeing; and, smoke. Twenty to sixty of them would fill like Thomas, I've seen and now I believe. the front seats of the lecture theatre; Buffalo shall hear of this." Need I add that
this easy reference, without a prefix, to a But when the International Medical New Testament saint, and this breaking Congress again met in London in 1913, the in on the Sabbath morning calm of their light of Lister's good work was shining disciplined wards, caused the caps of the before men, although his body had been High Church sisters of St. John to stand buried in peace. As we all know, Congresses straight up
from their heads. Lister beamed; and such-like events are commemorated he had no insular prejudices, and always by the issue of a medal. In monarchical liked the expansive manners of foreigners. countries it is a usual custom to engrave
How different from this chilly English the head of the reigning sovereign on one reception of 1877 was that extended to him side of the medal; and the medal of the only two years later at the International International Medical Congress in London Congress of Medicine at Amsterdam! The British Medical Journal4 tells of Lister's reception by the Congress with an enthusiasm which knew no bounds: “When he stepped forward to the desk to open his address (which was delivered, with but few notes, in improvised French), the whole assembly arose to their feet, and with deafening and repeated rounds of cheers, waving their hats and handkerchiefs, hailed the distinguished Professor of King's College with acclamations renewed minute after minute, and time after time, as his name was again shouted forth by some grateful and enthusi- The head of Lister which appeared on the International astic acolyte. This remarkable scene
Congress of Medicine Medal struck off in 1913, at London. unprecedented, we imagine, in the history of medical science continued for some in 1881 bears on the obverse the features of minutes, until Professor Donders, the presi- Queen Victoria. But in 1913, it was felt in dent, advancing with the distinctive grace Britain that there was only one effigy and dignity for which he is remarkable, and worthy of being stamped on the medal of a taking Lister by the hand, as he stood over- Congress in London, and that was the head whelmed with this magnificent ovation, of Joseph Lister. obtained a moment's silence, and addressing My audience will hardly believe me when him said, 'Professor Lister, it is not only our I tell them that in my student days the admiration which we offer you; it is our surgeon of one of the largest teaching gratitude, and that of the nation to which hospitals could always raise an appreciative we belong.'”
laugh by telling anyone who came into the Foreign surgeons attending the next operating theater to shut the door quickly, International Congress (it was in London in case one of Mr. Lister's microbes came in 1881) must have marvelled amongst in! Nor can they credit it that, as late as the themselves when they heard London and nineties of last century, another leading British surgeons attempt to cast doubt on surgeon had the courageous ignorance to the principles which Lister had evolved, publish the results of an experiment he and belittle the results he had given by made, in which the patients on one side of a basing his practice upon those principles. ward were treated by the older methods, 4 Brit. M. J., 1879, vol. ii, p. 453.
i. e., water-dressings, poultices, lint, oakum,
strapping ointment and so forth, and those on the other side with Lister's “antiseptic method.” The fact that Lister would never publish his statistics was another cause of offense. How could he, when he was carrying out operations never attempted before in the history of surgery?
The first case in which Lister wired a fractured patella—I suppose the first case in the world in which a healthy knee joint was ever opened for such a purpose—was in 1877. When I was his house-surgeon I
magnifique, mais ce n'est pas la chirurgie.” In his reply Lister simply said that he considered that was "chirurgie” which saved people's lives.
The public had not heard his name then, nor for many years afterwards. I remember soon after starting practice, I thought I would strengthen my position in one family by mentioning (quite casually of course!) that I had been house-surgeon to the great Sir Joseph Lister. “Yes,” said the patient, “a great man; he must have made a pile of money out of Listerine!”
When house-physician I remember telling Dr. Lionel Beale that I had just seen Lister resect a piece of rib in order to drain a pleural empyema. He was horrified and said I surely meant that Lister had simply tapped the pleura; and when I assured him of the fact, he said these surgeons would not stop till they had taken out the heart or resected the medulla oblongata!
Ovariotomy results at King's College Hospital had been so disastrous that the governors had forbidden the staff to undertake it. Lister changed all this.
Slowly, very slowly, but surely, his work was winning its way to recognition. But even then, as his principles were being accepted, recognition was given grudgingly. One of his own colleagues, Professor John Wood, said that Lister's fame came from Germany, that the “Germans were dirty people,” but that the antiseptic system "was not really necessary in England.” Efforts to depreciate him were made by saying that there was nothing in his methods except cleanliness, and late converts concealed their overdue repentance by rapturously embracing asepsis and vaunting its superiority over the “antiseptic system,” as it was still called.
But all this was later. In these early years of Lister's advent a little personal recollection will illustrate how slowly his evangel spread, yet how courageously confident he was of his mission. I was standing beside
had the honor of bringing together the first seven cases which he showed before the Medical Society of London in October, 1883. Some of them were recent and others old ununited fractures. All were successful. I remember the astonishment with which Fellows of the Society tried to feel the buried silver wire, and the surprise with which they heard that one patient had returned to his occupation as a bus-conductor, and was able to hop off and on his step and climb the bus stairs. But others were present who were aghast at the unwarrantable danger incurred in opening a healthy knee, and so running the risk of ankylosis, or of amputation and even death. One surgeon said that if the next case died Lister should be prosecuted for malpraxis, and another exclaimed: "C'est
5 Proc. M. Soc., London, 1884, vol. vii, p. 8.
him one day on the steps of the hospital in 1883 as he waited for his carriage to pull up, soon after the attack had been made on him for opening a healthy knee joint. He began by quietly remarking that the day must surely come when the profession would accept the principles of his methods, "and,” he added warmly, "if the profession does not recognize them, the public will learn of them and the law will insist on them.” Then, in one of those serious, almost solemn, and always arresting little speeches, into which he occasionally and unexpectedly dropped, he placed his hand on my shoulder and added pathetically, “Thomson, I do not expect to see that day, but you may.” Within a decade from that day he had left King's College Hospital, but not before his mission had been fulfilled. We all know the story. Sir James Simpson, a colleague of Lister's in Edinburgh University, asserted that "the man laid on the operating table in one of our surgical hospitals is exposed to more chances of death than the English soldier on the field of Waterloo."6
Before the coming of Lister the death rate in major operations was from 25 to 40 per cent; in other words, the chances were that one out of every 3 or 4 patients would die. These figures included cases which were not necessarily serious on admission. Nowadays the death rate is 2 to 3 per cent, and this is practically made up of cases admitted almost moribund, such as advanced intestinal obstruction, and others operated on in extremis with the faint hope of saving life.
Dealing with the surgical revolution of the Victorian era, Treves writes: “It is a question if any change in human affairs or any disturbance in human creeds has ever been at once so striking, so thorough, and
so unexpected as has been this stirring crisis of the healing art.8
Let us hearken to what one who was at no time his pupil said of Lister's work:
“Lister created anew the ancient art of healing; he made a reality of the hope which had for all time sustained the surgeon's endeavors; he removed the impenetrable cloud which had stood for centuries between great principles and successful practice, and he rendered possible a treatment which had hitherto been but the vision of the dreamer. The nature of his discovery-like that of most great movements—was splendid in its simplicity and magnificent in its littleness. To the surgeon's craft it was but 'the one thing needful.' With it came the promise of a wondrous future; without it was the hopelessness of an impotent past." (Treves.)
In 1892 Lister delivered his last lecture as he had to retire under the age limit of 65; but he was invited by the Council to continue his wards for another year and finally left King's College Hospital at the end of the summer session of 1893.
In 1897, the year of Queen Victoria's second Jubilee, he was made a peer on New Year's Day, his peerage having been the first ever conferred upon a surgeon. In the following May an address and a dinner were offered to him by his old pupils, and I had the honor of being the secretary of that festival. No less than thirty old house-surgeons and one hundred dressers were gathered together on that occasion, some of them having come from the far ends of the earth. Many have told me that they have never seen such a manifestation of personal esteem and admiration as that night when his health was drunk with Highland honors. I took the opportunity of reminding the chief of his words to me on
8 F. Treves. The Practitioner, 1897. vol. Ivii, June, p. 632.
6 “The Works of Sir J. Y. Simpson.” Edinburgh: 1871. vol. ii, pp. 289-392.
7 W. Watson Cheyne. The Practitioner, 1897. vol. Iviži, June, p. 632.