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tion them because Lister suffered more than any other member of the staff from their petty restrictions, their frigid rules, and their repressive formality. They made themselves particularly obnoxious to Lister, as he gave more work than any other surgeon; he visited his wards daily, instead of twice a week; he had the boldness to show himself at the Hospital after dinner, or even on a Sunday if a case gave him any anxiety; also the technique of his dressings involved much washing-up and the spreading of mackintoshes to limit the effects of the clouds of watery carbolic spray in which we then worked. At least two hours daily were taken up by dressings, which Lister insisted on carrying out himself or seeing carried out under his own eye; there was much upset in the wards by his having patients carried or wheeled into the operating theatre for his regular clinical demonstrations; in fact, he upset these pious ladies by disturbing the atmosphere they had created, which clearly suggested that medical men were allowed on sufferance in a hospital to do an operation or write a prescription, but that it was the nursing which took first place, and that the all-important points were that the bed should be stiffly tidy, the patient's face shinily clean, and that he should say his prayers!

Worse than these two cold douches was what John Stewart describes as the colossal apathy, the inconceivable indifference, shown by the students and surgeons of London. The wards of most of the hospitals in England at that time stank with the hospital air of putrefaction. I remember the tin tray placed below an amputated stump to catch the dripping pus, and the frequency with which in the postmortem room we saw the amyloid degeneration which indicated the patient's long and weary passage to the grave with hectic and surgical fever. Lister's wards were sweet; his dressings, when taken off, were free from putrefactive odor; they were handed round for confirma

tion, and I can remember the surprised and approving sniff with which the visitor— generally a foreigner-confirmed Lister's frequent and pleased remark: "You will note, gentlemen, that the discharge is serous and quite sweet."

Yet Londoners did not come to see this revolutionary change, to hear, to smell, and to be converted.

In Edinburgh his class frequently numbered four hundred students; in London some ten to twenty might turn up, but these gradually fell off. I have heard a carefully prepared, thoughtful, philosophic lecture, one which helped to lay the very foundation of a physiological understanding of our work, delivered by Lister to half a dozen men, and many a time I have seen him at work in theatre or ward, accompanied only by his own suite. When completed, this consisted of six dressers, three clerks (who must all have previously served as dressers) and his house-surgeon. Each office lasted for six months. It was only the enthusiasts, or those who had some inkling that they were serving a great master, who cared to give six to eighteen months to receiving this precious instruction in the science and principles of surgery. The rest cared for none of these things, they were indifferent, they were utilitarians, who, with what the world might in its foolishness call "shrewd common sense," saw that Lister's teaching was no use to them, for he did not coach them in the subjects required for examination, nor hand round the tips which were to get the student through. Lister noticed that though the London student has an affection for his school, he has none for the University of London where he graduates, or for the Royal Colleges where he takes his diploma, and hardly any for the city in which he studies. The Scotch student has more esprit de corps and more feu sacré in following a teacher or getting to the root of a subject. (Strange that we have to employ

French words to explain these un-English traits!)

The English student is keener on securing a diploma with which to earn his living. But is he entirely to blame for this? In London much is sacrificed to the examination system, which encourages cramming, stifles any spirit of inquiry or love of knowledge for its own sake, and compels the teacher to limit his instruction to preparing the student to pass, not only certain examinations, but certain examiners. The complete separation of teacher from examiner also handicaps the student. It is not the student who is to blame; it is our faulty methods of teaching and examination. Ten years later Lister referred to his small classes at King's, after his crowded audiences at Edinburgh, as “a humiliating experience."

But, if students and London surgeons were apathetic and short-sighted over the revolution being wrought in surgery, it was not so with the foreigners. In the entrance hall of the old Hospital there was a notice board forbidding smoking in English, French and German, thus:

Smoking forbidden

Il est défendu de fumer

Das Rauchen ist verboten.

In later years many must have wondered when the necessity had occurred for this polyglot announcement, for it was rare for any Frenchman or German to find his way there, and if he did, he was so solitary and felt so much the repressive atmosphere of our misty island, that he would hardly have had the hardihood to light an innocent cigarette. But it was different in the eighties. When I was Lister's house-surgeon in 1883, foreigners poured in from the ends of the earth, crowded the entrance hall, and there, while waiting for the master, they would make the air thick with tobacco. smoke. Twenty to sixty of them would fill the front seats of the lecture theatre;

indeed, I remember a time when the students complained of this and also of the fact that not infrequently Lister gave half his lecture in French or German, for he could make an extempore speech quite easily in either language. This complaint came round to Lister's ears, and I remember how he took the opportunity of a quiet day to refer to it, saying that if the students showed as much enthusiasm as the foreign visitors he would see to it that they were not ousted from the best seats. Like all his little corrections, this was said most courteously and more in sorrow than in anger.

Among the visitors from overseas we made many interesting acquaintances. I remember an American surgeon turning up one day who told me he had been to Vienna to see Billroth, but he did not consider him equal to a "bully operator" they had in Buffalo, from which the visitor came. He arrived at the hospital on Saturday just before lunch, and I told him Lister was not expected till two o'clock. He said he would wait, and asked if he could not look around the hospital in the meantime. I had the happy thought of turning him over to the secretary, whom he dragged all over the building and reduced to a limp mass before two o'clock.

When the master arrived promptly, our visitor said, "Professor Lister, Sir, I am told your wounds heal without suppuration, and I've come all the way from Buffalo to see them." The ever courteous professor said he was sorry, but that no cases required dressing that day; that the next day was a Sunday, and as he had no class he would be changing the dressings in the morning. The irrepressible visitor said, "No matter, I'll be there." And there he certainly was, on the Sunday morning. When all had been shown him he exclaimed, "Sir, I was like the doubting Thomas in the Scriptures, I would not believe without seeing; and, like Thomas, I've seen and now I believe. Buffalo shall hear of this." Need I add that

this easy reference, without a prefix, to a New Testament saint, and this breaking in on the Sabbath morning calm of their disciplined wards, caused the caps of the High Church sisters of St. John to stand straight up from their heads. Lister beamed; he had no insular prejudices, and always liked the expansive manners of foreigners.

How different from this chilly English reception of 1877 was that extended to him only two years later at the International Congress of Medicine at Amsterdam! The British Medical Journal 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 enthusiastic acolyte. This remarkable sceneunprecedented, we imagine, in the history of medical science-continued for some minutes, until Professor Donders, the president, advancing with the distinctive grace and dignity for which he is remarkable, and taking Lister by the hand, as he stood overwhelmed with this magnificent ovation, obtained a moment's silence, and addressing him said, 'Professor Lister, it is not only our admiration which we offer you; it is our gratitude, and that of the nation to which we belong.""

Foreign surgeons attending the next International Congress (it was in London in 1881) must have marvelled amongst themselves when they heard London and British surgeons attempt to cast doubt on the principles which Lister had evolved, and belittle the results he had given by basing his practice upon those principles. 4 Brit. M. J., 1879, vol. ii, p. 453.

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in 1881 bears on the obverse the features of Queen Victoria. But in 1913, it was felt in Britain that there was only one effigy worthy of being stamped on the medal of a Congress in London, and that was the head of Joseph Lister.

My audience will hardly believe me when I tell them that in my student days the surgeon of one of the largest teaching hospitals could always raise an appreciative laugh by telling anyone who came into the operating theater to shut the door quickly, in case one of Mr. Lister's microbes came in! Nor can they credit it that, as late as the nineties of last century, another leading surgeon had the courageous ignorance to publish the results of an experiment he made, in which the patients on one side of a ward were treated by the older methods, 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

Tympanum of Policlinco Umberto 1, Rome. The façade in bas relief shows Lister operating.

had the honor of bringing together the first seven cases which he showed before the Medical Society of London in October, 1883.5 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.

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!"

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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

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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

6 "The Works of Sir J. Y. Simpson." Edinburgh: 1871. vol. ii, pp. 289-392.

7 W. Watson Cheyne. The Practitioner, 1897. vol. Iviii, June, p. 632.

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.

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