Imagine making a discovery so important that a whole branch of science dates its calendar by it. That is what happened because of a Christian doctor. Joseph Lister’s discovery of antisepsis has led some to divide the history of medicine into the eras “before Lister” and “after Lister.” His work did more to save lives in the hospital than any other in history. Surprisingly, it took nearly a generation for his discovery to become accepted. He faced strong opposition from doctors and surgeons who didn’t believe him and weren’t about to change their ways. In the end, however, because of Lister’s perseverance in teaching what he knew was right, and from the dramatic success of those who followed his procedures, his ideas finally took hold, and at his death, he was a world-wide hero.
Born in a devout Quaker household, young Joseph learned about science at an early age. His father, Joseph Jackson Lister, a renowned amateur scientist himself, found a solution to the problem of chromatic aberration in microscope lenses. This discovery brought a major improvement to microscopy which had been around since Leeuwenhoek first made crude hand-held devices in the late 17th century. Leeuwenhoek had been the first to discover bacteria under the microscope. Astonishingly, it took two centuries for doctors and scientists to make a connection between the tiny creatures and disease.
Joseph Jr. quickly became an expert at the microscope. He studied at University College, London because Quakers and non-conformists were not allowed in Cambridge or Oxford. By 1850, at age 23, he was a doctor, with degrees in medicine and surgery. Three years later, he became the assistant of the great medical teacher Professor James Syme at Edinburgh, Scotland. Syme was very impressed and desired to groom Joseph to become his successor. The relationship was strengthened when Joseph became attracted to his daughter Agnes; the two married in 1856. Lister joined his wife in the Anglican church. Agnes took great interest in all of Lister’s work. On their three-month honeymoon touring the continent, what did they do but visit all the major hospitals of France and Germany! Though she bore no children, Agnes remained his most loyal and dedicated companion. She helped with Joseph’s home laboratory. She ran experiments, kept records and provided ample love and encouragement.
Needing surgery in a hospital operating room in the mid-19th century was almost a death sentence. Disease and infection were so rampant, chances of survival were slim. Hospitals were dark, stinking places filled with the screams of patients. The great killer was infection. No one knew what caused it. Bacteria were known, but were dismissed as passive microbes with no effect. Most surgeons suspected oxidation to be the culprit. They would hurry through their surgeries in hopes of keeping exposure to the air to a minimum. In hindsight, it is shocking to consider how unsanitary the conditions were. Surgeons would use the same blood-stained apron in surgery after surgery, and only washed their hands afterwards. If a surgeon dropped a scalpel on the floor, or on his dirty boot, he would just pick it up and continue operating. It’s no wonder that death rates for amputations ranged from 24% in America to 80% in Germany. A compound fracture or amputation of one finger could often result in 50–50 odds of dying.
Progress in sanitation was slow. Florence Nightingale found that cleanliness, fresh air and large, ventilated rooms aided survival, but the reasons were unclear. Ignaz Semmelweis promoted hand-washing in 1847 – another piece of advice that was soundly rejected by surgeons for a long time. As with most surgeons, Joseph Lister grieved over the high death rate of patients. What could be done? Lister’s familiarity with the microscope, and his respect for the scientific method learned in his youth, combined with his Christian compassion and humility, set him up for a great turning point. Louis Pasteur believed that “fortune favors the prepared mind.” Lister was about to illustrate this proverb.
One day around 1865 a colleague, a chemist, related to Lister how he had started catching up on his reading. He had found a ten-year-old paper by a relatively unknown French chemist (Louis Pasteur) that sounded interesting. Pasteur had found that rod-shaped bacteria caused fermentation in wine. He found that by heating the wine enough to kill the bacteria but not the yeast (a process that became known as pasteurization), wine could be kept from spoiling for long periods. Lister soon suspected that bacteria might be the cause of infection. He studied wounds with his microscopes, and sure enough, found rod-shaped bacteria (bacilli) present. What to do? He couldn’t heat his patients! But then he heard another report how sewers in France had been making the cows sick, but when the townspeople sprayed the sewage pits with carbolic acid, the smell was reduced and the cows remained healthy. That was it! He would try carbolic acid as a way to fight infection.
Soon he had a patient, a young man with a minor compound fracture. Lister used a sprayer he had invented to spray dilute solutions of carbolic acid on the wound and dressings. The results were dramatic. No infection set in, and the young man recovered completely. Encouraged by his results, Lister devised a set of procedures for spraying the wound, the surgical instruments and the operating room with carbolic acid. He would apply dressings with carbolic acid and replace them regularly. As he kept records, the death rate plummeted. Lister knew he had made a life-saving discovery and was motivated to spread the word. He published two major papers, in 1867 and 1870, that demonstrated the life-saving properties of what he named antisepsis.
One would think the world would be waiting for such news. The exact opposite happened. The medical community scoffed at Lister’s wild ideas. They did not believe him that bacteria caused infection. His elaborate rituals with carbolic acid were way out of the norm – too radical, too inconvenient, too crazy. For one thing, the stuff smelled awful, it made the surgeon’s hands look like red meat, and took too much time to go through all the procedures for something that, to them, made no sense.
Lister persisted. For years, no amount of teaching and demonstrating his techniques could overcome the professional inertia of the proud surgical community. Medical students from the continent, and younger students, were more accepting, but those in London and around the British Isles treated Lister’s doctrine with contempt. In America it was even worse. Debates raged about the new procedure; few believed it. Lister kept on with the fervor of an evangelist.
Only after the Franco-Prussian War (1870–1871), with its thousands of deaths from amputations, did French and German doctors flock to Lister’s lecture hall. So few of his own fellow Englishman attended, the college translated the “no smoking” signs into French and German. His new converts took the practice of antisepsis to the continent. As could be expected, survival rates skyrocketed. The success of Lister’s techniques could no longer be avoided once Robert Koch experimentally proved a connection between bacteria and disease in 1882. Even so, most of the older doctors had to die off before a new generation rose to accept and use the new practices.
Some converts to Lister’s antisepsis theory, particularly in Germany, advanced the methods of fighting infection. Inventive scientists found other disease-fighting chemicals. In 1879, an enterprizing inventor named his germ-fighting solution Listerine in Lister’s honor. And if anti-sepsis (fighting disease germs) was good, why not a-sepsis (preventing germs) in the first place? New aseptic techniques were tried: sterilizing everything, wearing clean garments, washing hands. By the late 1980s and into the 1990s it became routine to enter the operating room with sterilized clothing and instruments. Rigorous hand-washing was performed before contact with the patient. Surgical gloves and steam sterilization were invented. Cleanliness in medicine was very practically next to godliness. As for Lister, he cared not who got the credit, or whether doctors preferred antisepsis or asepsis – he was just glad that thousands of lives were now being saved. Thanks to the germ theory of disease and the practices advanced by Joseph Lister, the dirty operating rooms of centuries past were replaced with the bastions of cleanliness we know today.
Lister became one of the most beloved scientists and doctors in history. He was knighted by the queen. He was elected President of the Royal Society. A food-borne pathogen Listeria was named after him. His 80th birthday in 1907 was celebrated around the world. Some wanted him to be buried in Westminster Abbey, but Lister refused the honor. Upon his death at age 84, he was interred next to his beloved wife Agnes who had preceded him in death by 19 years.
Joseph Lister was a tall, handsome, unpretentious man loved by all his patients and colleagues. He cared for people and treated all his fellows with respect and congeniality. He loved the truth and contended for it with perseverance despite opposition. These virtues were the products of his beliefs. A fervent Christian all his life, he confessed, “I am a believer in the fundamental doctrines of Christianity.”
Let no modernist say, therefore, that Christian fundamentalism is a hindrance to good science. Millions are living and science is thriving due to the faith in action of a great scientist and compassionate doctor who, it can rightly be said, ushered in the age of modern surgery “after Lister.”