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The original of tiiis book is in 
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 http://www.archive.org/details/cu31924012168948 
 
Cornell University Library 
 R 489.L77W9 1913 
 
 Lord Lister; his life and work. 
 
 3 1924 012 168 948 
 
LORD LISTER 
 
 HIS LIFE AND WORK 
 
LORD LISTKR. 
 
 {licprocliitcd from the "'Xature' Science Winthics" Series bv permission of 
 Messrs. ilaeuiillan & Co., Ltd.) 
 
LORD LISTER 
 
 HIS LIFE AND WORK 
 
 G. T. WRENCH, M.D.(Lond.) 
 
 AUTHOR OF "THE MASTERY OF LIFE" 
 
 '||3 
 
 NEW YORK 
 
 FREDERICK A. STOKES COMPANY 
 
 PUBLISHERS 
 
{All rights reservecf) 
 
TO 
 
 MY ELDER BROTHER, 
 
 CHARLES, 
 
 AS A TOKEN OF AFFECTION 
 
 AND RESPECT. 
 
INTRODUCTION 
 
 It is impossible to separate a genius from all 
 time. His work, however much it may be 
 concerned with the special features of the period 
 in which he lived, is always founded upon the 
 first principles of life. Therein lies its distinc- 
 tion. The work of most men is concerned only 
 with the setting and spirit of the times in which 
 they themselves live. But the work of a genius 
 is based upon the unchangeable foundations of 
 human life and earns, in consequence, its im- 
 mortality. 
 
 The life and work of the late Lord Lister was 
 of this kind. It affected man's relation to sick- 
 ness and disease more fundamentally than the 
 work of any other philosophic physician devoted 
 to these problems. For Lister was emphatically 
 far more than a great surgeon : he was far more 
 the founder of modern surgery. He was a great 
 philosopher whose thought never deviated from 
 the central problem of life the mystery and 
 quality of vitality. As a philosopher Lister is 
 far too little known. Yet in the growing 
 recognition of the essential physiological basis 
 of life in all its branches and manifestations, 
 political, social, and religious, the name of Lister 
 
 7 
 
Introduction 
 
 will grow in greatness. As yet, however, even 
 in the more privileged circles of his own pro- 
 fession, the recognition of the astonishing power 
 and simplicity of his thought is but meagre. 
 Only recently one of the most distinguished 
 surgeons of our time summed up his impression 
 of Lister to me as a man who, chancing on a 
 great discovery, pushed it with the pertinacity 
 of a Scotchman. How fallacious such an 
 estimate is the present book will show. In part 
 this estimate was due to the general ignorance 
 about one of our greatest Englishmen, fbr Lister 
 was English, not Scotch. This ignorance itself 
 is largely due to Lister's modesty, the modesty 
 of great men which makes them certain that by 
 their works they will be proven and makes them 
 shun the loud proclamation to their own genera- 
 tion of the gifts that will have value for all 
 time. 
 
 Disease is the shadow of death that clouds 
 the life of man. When Lister was born this 
 shadow was probably deeper than at any other 
 time, so deep, in fact, that it threatened the very 
 existence of industrial populations . The problem, 
 then so urgent, has always been one that has 
 vexed man from the beginning of history. A 
 brief preliminary glance at man's philosophic 
 attitude to disease, by which he attempted to 
 discover the reason of its existence, is necessary 
 in order that the place of Lister may be properly 
 appreciated. 
 
 The Babylonians paid great heed to the 
 
 8 
 
Introduction 
 
 problem and mystery of disease. Devoutly 
 believing in the unity of man's being with the 
 universe, they wove man's fate into the successive 
 changes of the brilliant stars of their heavens, 
 and reconciled apparent chance and law in the 
 constancy of their inconstancies. The demons 
 of disease sallied forth to their fell work sup- 
 ported by some strange congress of the stars. The 
 primary health of man became read in terms of 
 the macrocosm, his healthy vitality conceived of 
 as the reward of a proper tmity between him and 
 the universal power. So even in this early stage 
 of man's history one sees disease shadowed forth 
 as a problem primarily of the disturbance of 
 man's vitality and secondarily of the demons that 
 take advantage of his lowered vitality. 
 
 The Egyptians were probably the most healthy 
 people of history. Herodotus spoke of them as 
 the healthiest nation, and Diodorus said that 
 from the king to his humblest subject the mode 
 of life in ^gypt seemed as if ordered by the 
 physician rather than the lawyer. The Egyptians 
 staved off disease by a reverent attention to the 
 vitality of the body. They were the first people 
 to master the question of antisepsis. By cassia, 
 frankincense, and myrrh they preserved the body 
 from the microbes of dissolution. But whether 
 it was that their vitality shielded them during life 
 from notable microbic attack or some other 
 reason prevailed, they confined' their use of anti- 
 septics to the preservation of the dead from dis- 
 solution and not the living from disease. 
 
 9 
 
Introduction 
 
 The Greek attitude to disease is chiefly centred 
 round the name of Hippocrates, the Father of 
 Medicine, and the contemporary of Socrates, the 
 Father of Reason. Both these philosophers 
 tended to ignore the primary question of vitality 
 and saw the fate of man in outward things, in the 
 environment of modem terminology. HipfK)- 
 crates believed in the ruling power of God, but 
 separated disease from the relation of man's life 
 to the overruling power. " Every disease has 
 its own particular mode of production from 
 natural causes," he wrote. Hence he is called 
 to-day the father of medicine by the profession, 
 which pays too exclusive a heed to the incidental 
 causes of disease, the causes that come from 
 without, and has not yet grasped the profound 
 significance of Lister's teaching upon the central 
 problem of the quality of human vitality. With 
 Hippocrates the physicians of to-day tend— often 
 with right, but not always so— to regard those, 
 who seek to understand the profounder problem 
 as to why disease, so rare in animals and natural 
 or savage peoples, should be so prevalent 
 amongst the civilized, as faith-healers, purifiers, 
 vagabond priests, and imp>ostors (^ayoi koI Kad- 
 dprav Koi ayvprai kcu dXa^owes). 
 
 Hippocrates was followed by the anarchy of 
 thought which ensued with the decadence of 
 Greek civilization. Quackery, peculiar cures, and 
 sects were the transient fashions and means of 
 combating the increasing disease. Galen, the 
 Court physician to the Emperor Marcus Aurelius, 
 
 lO 
 
Introduction 
 
 attempted to restore some imperial power and 
 order to the anarchy, of medicine. He was 
 followed by Christianity, with its exclusive regard 
 to the spiritual side of life. In the knowledge 
 of the body, its vitality and physiology, a 
 thousand stagnant years followed the era of 
 Galen, years in which sickness and disease grew 
 apace and often reached an appalling magni- 
 tude. The works of Galen and Hippocrates were 
 only saved from the deluge of theology by the 
 followers of Mohanamed, who were the first to 
 establish an efficient hospital system with medical 
 training colleges and physicians to govern both. 
 With the revival of learning the body once 
 again received attention from learned men. The 
 knowledge of physiology and anatomy increased. 
 William Harvey (i 578-1657) discovered the cir- 
 culation of the blood. Antony von Leeuwenhoek 
 in 1683 discovered the existence but not the sig- 
 nificance of microbes. Some rarer thinkers em- 
 ployed themselves with the philosophy of disease 
 as a whole, and of them I would choose the noble 
 Fleming van Helmont (i 577-1 644) as the most 
 devout and coherent genius. According to van 
 Helmont, a ruling and living spirit, which he 
 named the Archaeus, dwelt in and governed the 
 whole organism of the body, and in every bodily 
 organ or structure dwelt lesser spirits or local 
 Archsei. Disease was either due to an attack 
 upon the local Archseus, which eventually affected 
 the central Archseus, or else it was a defect or 
 morbid humour of the central Archasus. The 
 
 II 
 
Introduction 
 
 symptoms of disease were the evidence of the 
 anger of the Archaeus, the fever was the heat 
 of his anger, the secretions poured out were his 
 attempt to soothe injured or irritated tissue. In 
 this form van Helmont expressed the central 
 vitality and the local vitalities of the body which 
 Lister so admirably demonstrated and in which 
 he found the final clues to the mystery of disease . 
 Between van Helmont and Lister nothing was 
 added to the fundamental philosophy of disease, 
 though detailed knowledge was much increased. 
 I cannot, therefore, bring this brief Introduction 
 to a close in a better manner than by quoting 
 the prayer of van Helmont, which he uttered in 
 despair after finishing his review of medicine and 
 the terrible prevalence of disease : " O merciful 
 God, how long wilt Thou be angry with man, 
 that Thou hast not revealed one truth to Thy 
 students in healing? Is this Moloch sacrifice 
 pleasing to Thee, and wilt Thou that the lives 
 of the poor, of widows, and of childten, be con- 
 tinually offered up to Thee in miserable torments 
 of incurable diseases or through the carelessness 
 and ignorance of physicians ? " The prayer was 
 not uttered in vain, and that it was not uttered 
 in vain has been due, under Providence, to the 
 life and work of Lord Lister. 
 
CONTENTS 
 
 Introduction . 
 
 CHAPTER 
 
 I. Lister's Childhood and Student Days . 17 
 
 II. Lister and James Syme • • • 37 
 
 III. The Defeat of Charity . . . -63 
 
 IV. Perplexity and Enlightenment . . 80 
 V. The Dawn of Success . . .101 
 
 VI. The Way to Perfection . . . 119 
 
 VII. The Miracle . . . i";© 
 
 VIII. The Spread of the Good Tidings . . 168 
 
 IX. Edinburgh ..... 
 
 X. Too Late! ..... 
 
 XI. The Further Spread of the Good Tidings . 244 
 
 XII. London and the Final Acceptance . 273 
 
 XIII. Simplicity and Boldness .... 292 
 
 XIV. Honours and Death .... 337 
 XV. Conclusion . . . . 359 
 
 Index . . . . . .381 
 
 13 
 
 199 
 230 
 
ILLUSTRATIONS 
 
 Lord Lister ..... Frontispiece 
 
 FACING PAGE 
 
 Upton House, where Lister was born . .18 
 
 Glasgow Infirmary . . . . .152 
 
 Edinburgh Infirmary 
 
 15 
 
 204 
 
LORD LISTER 
 
 CHAPTER I 
 
 LISTER'S CHILDHOOD AND STUDENT DAYS 
 
 The neighbourhood of West Ham is not noted 
 for the crystalline atmosphere, the dry, exhilarat- 
 ing airs, and the azure sky one is wont to think 
 of as favouring the cradle of genius. Yet it 
 was in this neighbourhood, in Upton Lane, that 
 Joseph Lister was born, upon April 5, 1827. 
 
 In 1827, however. West Ham' was more genial 
 than it is now, and Upton itself was a village 
 set amidst pleasant meadow-lands. The River 
 Lea, now " enamelled filthily with many hues," 
 then wandered through verdant fields where cattle 
 grazed and the scent of meadow-sweet and cow- 
 slips burdened the summer air. 
 
 In this pleasant neighbourhood of London a 
 number of Quaker families had gathered. The 
 chief of these was that of Samuel Gurney, known 
 as the " bankers' banker " and head of the greatest 
 discounting house in England. His sister, the 
 famous Elizabeth Ery, who herself did so much 
 for the sufferers in hospitals and prisons, also 
 lived near her brother. 
 
 17 B 
 
Lord Lister 
 
 The Listers were a Quaker family, and Upton 
 therefore oflfered attractions to Joseph Jackson 
 Lister, the father of Lord Lister, and son of 
 John Lister, a London wine merchant, whom 
 he followed in business. The Listers were, like 
 most Quaker families, men of sober and capable 
 character, earning both a good name ajid com- 
 fortable wealth in business. Joseph Lister, the 
 elder, topk a house, still knoiwn as Upton House, 
 and situated in Upton Lane. At that time Upton 
 House was surrounded by a spacious garden and 
 fields, the whole estate counting sixty -nine acres. 
 The estate is now cut up into roads lined by 
 rows of workmen's cottages, but the house still 
 exists and forms to-day the vicarage of St. 
 Peter's Church. It is an ideal family house, 
 solidly built and admirably proportioned, with 
 an exterior which, in spite of the inevitable 
 London grime, is dignified and pleasing. The 
 rooms are large and suitable to the expanding 
 activity of childhood, with staircases, passages, 
 cupboards, and nooks, which seem specially 
 designed for children's romps and glorious games 
 of hide-and-seek. Immediately opposite to 
 Upton House was Ham Park and House, belong- 
 ing to the friends of the Listers, the aforesaid 
 Samuel Gurney and his family, a neighbourhood 
 that was a delightful one to the children, but 
 which once was nearly the occasion of a disaster 
 to young Lister. A friend was shooting in Ham 
 Park, and in his excitement shot in such a way 
 that the pellets of his gun passed through the 
 
9 >^ 
 
 
Lister's Childhood and Student Days 
 
 window of the dining-room of Upton House and 
 embedded themselves in the wall against which 
 the boy was standing. 
 
 Lister's father was a man of marked though 
 not great genius. As a child he was short- 
 sighted, and in order to see the landscape more 
 comfortably from his nursery window he was 
 accustomed to glue his eye to an air-bubble which 
 had become imprisoned in the glass. The air- 
 bubble acted as a lens, and enabled the boy to 
 see the country with greater ease. Only a genius 
 could be led to a valuable discovery by such a 
 simple observatioja . Lister, the elder, was such 
 a genius . From the time of his youth the subject 
 of optics absorbed his leisure . At that time 
 microscopes of high power always presented an 
 image with blurred and coloured outlines, which 
 obscured the clarity and decision of presentation. 
 Lister set himself to overcome this obstacle. But 
 it proved embarrassing. Experiments with 
 glasses variously arranged led to conflicting 
 results. Lister, however, was not to be baffled. 
 He had the tenacity, the carefulness, and the 
 judgment that were in such abundant measure 
 the qualities of his more famous son. He had 
 obtained results from his experiments which 
 seemed highly contradictory. He brooded over 
 them, and out of the irreconcilable educed in 
 1830 a common principle upon which the con- 
 struction of the high -power lenses of the micro- 
 scope have since been based. Acting under its 
 guidance, he was able to put together sets of 
 
 19 
 
Lord Lister 
 
 lenses so that the blurring of the picture was 
 abolished. The law of aplanatie foci which he 
 evolved enabled him to make the first perfect 
 English achromatic microscopes. 
 
 In recognition of his scientific achievements. 
 Lister received the high distinction of being 
 elected a Fellow of the Royal Society, being the 
 first man to establish a firm reputation upon a 
 bubble. 
 
 In 1 8 1 8 he married the daughter of Anthony 
 Harris, of Maryport, Cumberland. Their union 
 was blessed with seven children — four sons and 
 three daughters. Joseph Lister was the second 
 son. The home atmosphere in which he was 
 brought up may be said to be that in which he 
 continued to live all his life. It was one of 
 comfortable afifluence, earnest faith, and practical 
 goodwill, the qualities distinctive of a great num- 
 ber of Quaker families, added to which was the 
 devotion to science and to microscopical study 
 which was the chief occupation of his father's 
 leisure hours. 
 
 The child is father of the man, and as a child 
 Lister displayed upon the smaller stage of child- 
 hood the character which later earned for Mm 
 such high regard. He was affectionate, and to the 
 end of his life showed the same devotion to his 
 family. He was merry and full of high spirits 
 at home, but shy with strangers, and from the 
 first he displayed an unusual gravity and high 
 conscientiousness whenever the more serious side 
 of life was approached. His conscientiousness 
 
 20 
 
Lister's Childhood and Student Days 
 
 was, indeed, peculiarly sensitive, and gave him 
 a refined sense of truth both to himself and to 
 others, which showed him as free from guile, 
 and gave him the accurate sense of reality which 
 became so profitable to the world. 
 
 His life as a child was happy and serene. 
 There are no notable anecdotes connected with 
 it, and he himself was the last to desire the 
 repetition of such anecdotes. "A scientist's 
 public life lies in the work that is his," was his 
 saying, and in the biography of his father which 
 he wrote for the " Dictionary of National 
 Biography," he carefully observed this rule. He 
 made no mention of the childhood or private 
 life of his father, but retailed in full the history 
 and character of his contribution to. the world's 
 knowledge. Such is the standard of scientific 
 biography which Lister himself set, a standard 
 he was anxious should be observed in the case 
 of his own life. 
 
 His early education was given to him at the 
 Quaker school, at Grove House, Tottenham. 
 Amongst his schoolfellows was Wilson Fox, the 
 well-known physician, who was three years 
 yoimger than Lister, and William Forster, the 
 Liberal statesman, who was a few years older. 
 
 The headmaster of the school was a Mr. 
 Binns, a good but in no way remarkable man. 
 The character of Mr. Binns with the traditions 
 of Quakerism ftormed the character of the school . 
 To us, who in these latter days have what, I 
 cannot but think, is a somewhat dangerous free- 
 
 21 
 
Lord Lister 
 
 dom, the records of this school give a picture of 
 unerring and almost stupefying goodness. The 
 masters were good, the boys were good ; the 
 address of the Friends in the " thou and thee " 
 and the eminent piety of the Quakers ruled 
 throughout. But of the high moral stamp the 
 school gave to its pupils there can be no question, 
 and this school confirmed in yoiung Ljister the 
 strictness of his sense of truth and of his duty, 
 to his fellow-men, from which in later life he never 
 for one instant swerved. The intellectual educa- 
 tion that was given to him was thorough both 
 on the classical and scientific sides, and he 
 proved himself an able pupil, distinguished by 
 thoroughness rather than brilliance. Both at 
 school and with his father he learned to observe 
 and record accurately, and he soon became 
 familiar with the microscope and the preparation 
 of sections. He also proved himself a good 
 linguist, and at a later date upon his tours abroad 
 was able to address his audiences in either the 
 German or the French languages, an unusual 
 accomplishment for an Englishman who had not 
 lived in the coxmtries where they are spoken. 
 
 From this efficient school Lister in 1844 pro- 
 ceeded to University College. The familiar build- 
 ing in Gower Street, designed by William 
 Wilkins, R.A., and perhaps the most pleasing 
 piece of classical architecture in London, had 
 been built only a few years. It owed its origin 
 to a letter from the poet Thomas Campbell 
 to the Times in 1825. Campbell urged in a 
 
 22 
 
Lister's Childhood and Student Days 
 
 very powerful manner the establishment of a 
 University of London. Oxford and Cambridge 
 of course were outraged at this suggestion, but 
 in the teeth of the opposition of the many power- 
 ful sons of the classical universities, the project 
 was carried through and the Gower Street build- 
 ing erected as the home of the new university. 
 It was known as the University of London up 
 to 1836, but at that date the University was 
 separated from the specific building, which then 
 became known as University College. But it 
 maintained its premier position in London educa- 
 tion, and in sending his son to the College the 
 elder Lister gave him the best education in 
 England, apart from the peculiar social stand- 
 ing that the older universities alone could give. 
 
 Lister matriculated in the year 1845, ^^'^ 
 though he passed his examination with distinction 
 and received honours in classics and botany, he 
 did not single himself out by gaining a scholar- 
 ship or gold medal. Two years later he took 
 his B.A. degree, but failed to distinguish him- 
 self by earning either gold medals or honours. 
 Though he had a sound general knowledge, he 
 had not the exceptional power of storing other 
 people's facts and opinions which is, perhaps, 
 the chief faculty through which a student gains 
 distinctions in these examinations. Where 
 originality had greater weight, there, as we shall 
 see, he at once became notable. 
 
 The scientific bent of his father and his own 
 inclination led Lister to take up the study of 
 
 23 
 
Lord Lister 
 
 medicine, and he passed directly from University 
 College to University College Hospital and its 
 medical school. The choice was a peculiarly 
 happy one and a part of that general right- 
 ness and lack of wastage by blunder and error 
 which was characteristic of Lister's whole 
 career. 
 
 Before the foundation of University College 
 and its hospital medical education in London 
 had been in a deplorable way. It was without 
 shape or organization. There was no examining 
 body which could give a student a doctor's 
 degree. A student in Londbn, he studied in 
 London, but to earn his degree he had to be 
 tested elsewhere, and by men who did not always 
 regard metropolitan products with eyes free from 
 jealousy. The aspiring student was, therefore, 
 semi-detached. 'He had to contort his mental 
 vision so as to fix his attention upon his London 
 studies and his future judges at the same time, 
 and to consider whether the particular method 
 he was being taught would be approved of by 
 his examiners and therefore worth learning. 
 
 The absence of organization which character- 
 ized the system of examination for degrees was 
 also to be found in the teaching. Capable and 
 efficient teaching could only be got if the student 
 was fortunate enough to place himself under a 
 zealous master. At some medical schools con- 
 sequently lectures and instruction were efficient, 
 at most they were inefficient, able in one subject, 
 feeble or altogether lacking in other subjects, 
 
 24 
 
Lister's Childhood and Student Days 
 
 and in general extraordinarily short and cursory 
 compared to the efficiency that with order might 
 have been obtained. Thus the celebrated sur- 
 geon Cline combined anatomy, physiology, and 
 surgery in one course, and he was held to be one 
 of the ablest and most thorough of teachers ; 
 and at St. Bartholomew's there was no class in 
 anatomy at all . The anatomy of the human body 
 is a matter of some familiarity to many people 
 of the present day, but at the beginning of the 
 nineteenth century it was not well known even 
 to the students and practitioners whose business 
 it was to see that the body could be restored 
 to good working order. Nor did the Govern- 
 ment or public opinion help the profession in 
 this matter, but refused official recognition to the 
 obtaining of the necessary material, and by their 
 opposition promoted the horrible and secret 
 system of body-snatching that prevailed. Men 
 known as Resurrectionists used to dig bodies out 
 from the graves or waylay drunken men in the 
 alleys of London, throttle them, and take their 
 bodies to the anatomists, who paid them from 
 £5 to £15, according to the "market value," 
 and asked no questions. 
 
 The apprenticeship system of learning medi- 
 cine was also in vogue, vmder which a student 
 was only compelled to walk the hospitals for 
 fifteen months and could spend the rest of his 
 time under a practitioner, with whom he as a 
 rule learnt much shrewdness, more humbug, and 
 no science. 
 
 25 
 
Lord Lister 
 
 Lister entered medicine as a student when this 
 deplorable, haphazard inefficiency was being 
 rapidly eradicated. The Anatomy Act had been 
 passed owing to the strong representations of 
 some leading London men, and the abomination 
 of body-snatching thereby done away with. The 
 same men and others of influence established the 
 London University, and in the University College 
 Hospital and Medical School set up a well- 
 ordered system of medical education, which was 
 to be the standard and example eventually to 
 be followed by all other medical schools and 
 hospitals. Professors were appointed, regular 
 and thorough courses of lectures in chemistry, 
 materia medica, medicine, anatomy, physiology, 
 and surgery were for the first time given, and the 
 period of study was doubled. 
 
 It was into this excelling system and hospital 
 that Lister entered in his twentieth year. He 
 had not notably, distinguished himself in his 
 schooling and examination for the B.A. degree. 
 But directly he entered medicine Lister got into 
 his stride. He was soon recognized as the best 
 student of his year, and it was clear that he 
 was destined for high honours. His first exami- 
 nation stamped his value. The University 
 examiners gave four gold medals. Lister pro- 
 cured two of them and was very close toi securing 
 the other two. In 1852 he took the degree of 
 M.B.Lond., and once more showed his capacity. 
 Besides distinguishing himself in other subjects, 
 he took the gold medal and scholarship in 
 
 26 
 
Lister's Childhood and Student Days 
 
 surgery, and thus started where he ended, at 
 the very top of surgery. In the same year he 
 became a Fellow of the Royal College of 
 Surgeons . 
 
 In his student career Lister came across three 
 men who had a marked effect upon him and his 
 career. The first was Professor Lindley, the 
 botanist. Lister gained with him the love of 
 flowers which gave him so much pleasure. Upon 
 all his holidays and excursions he gathered the 
 flowers that he saw and carefully pressed and 
 preserved them, and his collection of Alpine flora 
 eventually became a large and valuable one. 
 It was not as a scientist that he pursued this 
 hobby of botany, but as a genuine lover of the 
 wonderful beauty the many flowers of the hill 
 and field yield to those who search for it ; and 
 Lister found no distraction from the horrors of 
 hospital more gentle or effective than that which 
 the bright blossoms of the country offered. The 
 other two men were also professors. Thomas 
 Graham, the able professor of chemistry, taught 
 Lister the grasp of chemistry which was of great 
 value to him in his later work. The last friend 
 and teacher was a very remarkable man who 
 made a great impression upon his students, 
 William Sharpey, the Professor of Physiology. 
 Sharpey was precisely the type of man to inspire 
 a youthful enthusiast. Destined for medicine, he 
 studied at Edinburgh and Paris. At Paris he 
 formed a lifelong friendship with James Syme, 
 Lister's future master and father-in-law. Re- 
 
 27 
 
Lord Lister 
 
 turning to England, he went into general practice, 
 but soon found that practice without progress 
 was unsuitable to his aspiring mind. He deter- 
 mined, therefore, to devote himself to a single 
 province of the medical art, and he carried out 
 this determination in a very singular way. 
 
 With a knapsack upon his back and a staff 
 in his hand he set out in 1826 to tramp on foot 
 through France and Switzerland to Rome and 
 Naples, studying at all the famous places en 
 route. In 1828 he turned northward, passed 
 through Bologna, studied with the famous Panizza 
 in Padua, went on via Venice and Innsbruck to 
 Vienna, and later by Heidelberg to Berlin and 
 home, having spent three years upon a pilgrimage 
 that is unique in medical history, and bringing 
 back the weight of all Europe's knowledge in 
 physiology and anatomy, together with a knap- 
 sack full of material goods. The Governors of 
 University College, astute in securing the best 
 men of the time, appointed him professor. 
 
 His work and lectures revolutionized physi- 
 ology and made it the vital science that it is 
 to-day. In Germany, especially, he had learnt 
 the value of the microscope in examining the 
 minute tissues of the body, and he combined his 
 knowledge of their minute structure with the 
 functions they carry out in such an absorbing 
 manner that his lectures were crowded and their 
 substance became classical. 
 
 It is scarcely likely, therefore, that such a man 
 would not be interested in the son of laim who 
 
 28 
 
Lister's Childhood and Student Days 
 
 had shown himself to be " the pillar and source 
 of all the microscopy of the age." He became 
 interested in young Lister, and the latter soon 
 became his favourite pupil. Sharpey was a man, 
 not only of lively enthusiasm and originality, 
 but of conimanding presence, and it was but 
 natural that a student would respond to his per- 
 sonal power. With his help Lister began that 
 combination of research work with his practical 
 work which developed into the keen two-edged 
 sword of his later execution. 
 
 His first piece of scientific research was carried 
 out in 1852. The subject was one in no way 
 connected with his later work, though he made 
 some slight use of it. It was, indeed, the for- 
 tuitous product of an observant student. Mr. 
 Wharton had occasion to remove a piece of iris 
 from a patient's eye. The iris is the screen or 
 shutter which regulates the amount of light that 
 enters the eye by making the pupjl smaller or 
 larger, and also gives the eye its characteristic 
 colour. The means by which the iris dilates 
 and contracts were not then well known. Lister, 
 whom Sharpey had interested in the general 
 question of automatic or involimtary muscles and 
 who was present at the operation, took his oppor- 
 tunity. He examined the piecte of iris and was 
 led from it to an examination of the irises taken 
 from dead animals. The work preceded the 
 passing of his final examination, and with this 
 ordeal, properly dreadted by all students, before 
 him, he was unable to complete his work to his 
 
 29 
 
Lord Lister 
 
 satisfaction. As he modestly worded it : "My 
 engagements do not allow me to carry, the inquiry 
 further at present ; and my apology for offering 
 the results of an incomplete investigation is that 
 a contribution tending, in however small a degree, 
 to extend our acquaintance with so important an 
 organ as the eye, or to verify observations that 
 may be thought doubtful, may probably be of 
 interest to the physiologist." 
 
 In spite of this modest approval of its author, 
 the paper was considered worthy of publication in 
 the leading microscopical journal, which was no 
 small honour to a student. One cannot help 
 musing over this beginning of Lister's course. 
 The paper did, as a fact, show the way in which 
 the iris acted, as was confirmed by later work, 
 but it itself was not complete. As such, though 
 the first piece of original work Lister ever did, 
 it is unique in being the only one that he ever 
 published in an incomplete state. In future he 
 never gave anything out until he was quite satis- 
 fied that it was complete in itself. In this he 
 resembled his great contemporary Charles 
 Darwin, though the vital importance of Lister's 
 work to his fellow-men compelled him to publish 
 each completed step of his progress. The 
 examination of the involuntary muscles of the 
 eye led Lister to an investigation of that 
 curious condition which is due to the con- 
 traction of the small muscles in the skin and 
 which is popularly known as "goose-skin." 
 The paper confirmed the " simple and beautiful 
 
 30 
 
Lister's Childhood and Student Days 
 
 explanation " of Professor Kolliker. Both this 
 and the previous paper were illustrated with some 
 exquisite and accurate drawings by Lister him- 
 self, who had an exceptional talent of which, as 
 of his other gifts, he made great use in his work 
 of discovery. 
 
 These early papers had no particular bearing 
 upon Lister's later work, though his later work 
 had a very definite bearing on them. For it is 
 an interesting witness to the way in which Lister's 
 discoveries delved into every part of medicine, 
 that these early investigations, then so difficult, 
 would now be easy, and' this ease has come 
 through the application of Lister's principles and 
 practice to microscopical science. Lister in his 
 first paper expressed his gratitude that the iris 
 tissue did not decompose so rapidly as he had 
 anticipated, and that consequently he had time 
 for his observations. But now in the light of 
 the knowledge that he has thrown upon decom- 
 position there is no need for hurry, and both 
 microscopical tissues and the body by dissection 
 can be examined at leisure. It is a technical 
 matter, but in effect it means this, that Lister in 
 discovering the way to prevent the decomposition 
 of wounded tissues in the living, opened the way 
 to the prevention of decomposition in the dead 
 tissues, whether in the dissecting-room or the 
 laboratory. The good that has resulted there- 
 from to medicine and surgery, and through them 
 to mankind in general, is a part of the cumulative 
 effect of Lister's genius. 
 
 31 
 
Lord Lister 
 
 Although it seemed that young Lister, under 
 the influence of his father and Sharpey, would 
 direct himself to microscopical anatomy, yet even 
 at University College Hospital, in combination 
 with this work, the first movement of the sym- 
 phony of his life had begun. In his surgical 
 studies he was first dresser and then house- 
 surgeon to John Eric Erichsen, the Anglo-Dane 
 and author of one of the most fattious textbooks 
 of surgery in the English language. 
 
 As house-surgeon Lister had patients put 
 definitely in his charge . Such direct contact with 
 the actual gives above all the real chance to 
 originality. No parent or teacher, however help- 
 ful, supervened ; and Lister for the first time 
 became intimately acquainted with the appalling 
 forms of blood-poisoning, and above all the ter- 
 rible disease, now banished by his work, known as 
 " hospital gangrene "—a disease in which wounds 
 that should heal cleanly became the centres of 
 spreading mortification, and the living tissues 
 rotted away with fearful rapidity. Lister had now 
 to deal with this disease. The method in vogue 
 was to put the patient under chloroform and burn 
 the mortified flesh away with caustics. Some- 
 times this treatment was successful, sometimes 
 in a few days the grey^ish film would appear at 
 the edge of the wound again, presaging the 
 general greyness of death that ensued. But the 
 very fact that the treatment was sometimes 
 successful riveted the attention of the positive, 
 constructive mind of Lister. To discover how 
 
 32 
 
Lister's Childhood and Student Days 
 
 that success was brought about, therein lay the 
 clue to the disease and its conquest. 
 
 Up to that time the cause of putrefaction in 
 wounds, of gangrene and suppuration, had loosely- 
 been held to be the oxygen in the atmosphere, 
 which set up fermentation in the juices of the 
 wound. Lister had the genius to see the obvious 
 instead of the conventional . If sometimes caustics 
 burnt away the disease, clearly they burnt away, 
 not the oxygen in the air, but something purely 
 local, something in the woimd itself which could 
 sometimes be destroyed, and this local thing was 
 the cause of the disease. Lister set out to find 
 it with the enthusiasm and hope of a young 
 scientist. He did not himself publicly speak of 
 the burning hope that filled his breast, but any 
 young scientist who has entertained a like vision 
 can be sure that he was elated. He took his' 
 microscope and carefully examined pieces of the 
 diseased tissue. He saw certain peculiar objects. 
 In them, perchance, he saw the cause of this 
 awful disease. One can, again, imagine that he 
 felt the thrill of a great hope, that seems to make 
 one expand as heat "makes metal expand. But 
 Lister only recorded in sober scientific lan- 
 guage : "I imagined they might be the materies 
 morbi in the form of some kind of fungus." 
 The investigation got no farther than this 
 seeing. He knew of no means then of 
 furthering it, nor were there any means. He 
 was far from being ripe for discovery. One 
 cannot leap to great truths until long training 
 
 33 c 
 
Lord Lister 
 
 and care have made the leap possible and 
 accurate . 
 
 Lister, therefore, merely held in his thought 
 the possibility of a minute living organism as 
 the local cause of the disease. He made notes of 
 his observations and drew his usual careful and 
 excellent pictures. So accurate were the latter 
 that, speaking fifty years later, he said these 
 pictures were still of use to him', a striking illus- 
 tration of the continuity and harmony of his life, 
 which justifies one in calling these first observa- 
 tions and meditations the first movement in the 
 sylmphony of his life. 
 
 As to Lister himself in these days, he is 
 described as a youth of average height but 
 slender build, with a large intellectual head, a 
 lofty brow, and a grave and earnest f!a;ce. 'His 
 hair was dark and luxuriant, and he wore the 
 side -whiskers that were conunon at this time. 
 He used to dress in black, wearing a high collar 
 and black stock and the peculiarly cut coat that 
 denoted that he was a Quaker. Altogether he 
 presented rather a sober figure for a youth, but 
 one impressive toi those who could read a 
 character of profound thoughtfulness and noble 
 sincerity and feeling. 
 
 But upon his holidays and with those he loved 
 his gravity fell from him, and he showed the 
 gaiety that is more deep, if one may use thfe term', 
 because of that very gravity, having a sincerity 
 in it, a genuineness, an originality that separates 
 it from the more imitative and artificial gaiety of 
 
 34 
 
Lister's Childhood and Student Days 
 
 lesser natures. He had the gaiety that was glad, 
 but had no need of company, not the gaiety that 
 is only aroused by company, and he possessed it 
 all his life, so that though a grave and serious 
 man to the eyes of most, he was never a sad 
 man. "He was fond of open -air exercise, and 
 especially of swimming. The latter exercise led 
 to an observation which I think to be of great 
 interest. When bathing and swimming in the 
 sea the fishermen watching him were wont to 
 speak in terms of admiration of his excellently 
 proportioned and graceful form. His brother 
 and .other friends bathing with him were healthy 
 and well-built fellows, but Lister showed himself 
 favoured with a singular perfection of body. To 
 me it seems that such perfection of physique is 
 rarely, if ever, absent from g^eat constructive 
 genius. 
 
 Lister's repute with his teachers at University 
 College was high. His zeal and earnestness 
 impressed them. By the students he was re- 
 garded with equal consideration. In their 
 medical society he was elected secretary and later 
 president. Associated with him in this society 
 were young men of quite exceptional quality. 
 Besides himself, three other students succeeded 
 to the rare honour of the Fellowship of the Royal 
 Society : Sir William Flower, the zoologist, 
 J. S. Gamgee, eponymously popular in " Gamgee 
 tissue," and Sir William Roberts, the physician. 
 Other names familiar to all medical men were 
 associated with his. It was a period of 
 
 35 
 
Lord Lister 
 
 exceptional vigour, but there can be little doubt 
 that much of this vigour was due to the zeal 
 with which Lister's profound and earnest per- 
 sonality inspired the more capable students with 
 whom he came in contact. 
 
 36 
 
CHAPTER II 
 
 LISTER AND JAMES SYME 
 
 At the anniversary dinner of the Royal Society in 
 1902, Lister, made President in 1895, i^ose to 
 respond to the highest honour the Society could 
 confer upon him, the gift of the Copley Medal. 
 In acknowledging the honour he declared that 
 perhaps his chief merit lay in the fact that he 
 worked for years together with exceedingly little 
 encouragement from his professional brethren. 
 There were, however, two great exceptions, his 
 father-in-law, James Syme, and his students. 
 
 Sharpey, Syme's friend, knew the value of 
 personality in developing genius. Lister had 
 finished his house-surgeoncy at University College 
 Hospital, and Sharpey, in looking round upon 
 the distinguished surgeons of his time, found no 
 more distinctive figure than that of his friend 
 and fellow-student to whom he could entrust the 
 further fate of his favourite student. So he gave 
 Lister a letter of recommendation and sent him 
 off upon a medical pilgrimage to Edinburgh, 
 where Syme had already been professor of 
 clinical surgery for twenty years. 
 
 Once again one is apt to think that Lister was 
 
 37 
 
Lord Lister 
 
 blessed with a providential good fortune. Not 
 only was he gifted with a handsoime presence and 
 a fine intellect, but he was also favoured with 
 a healthy and happy home, a sympathetic and 
 highly talented father, a sdhool which confirmed 
 and strengthened the d^efinite shape of his 
 character, the leading medical school for his 
 education, and in Sharpey the most original and 
 zealous of teachers and friends. It was indeed a 
 happy combination, but one must not forget that 
 a positive, helpful, and world-befitting genius 
 will probably spring from good stock, and that 
 such a genius, by good judgment and through 
 the favour that is shown to obvious merit, will 
 make very few errors in the forward path, and 
 that what seems the result of happy chance is 
 really due to ability. It is only when, the 
 creations of genius rim counter to the conventions 
 of man that the struggle comes. 
 
 The decision of Lister and his friends for him 
 to visit James Syme was fully in accord with the 
 happy sense of his life. As Sharpey was the 
 most talented and original physiologist of his 
 time, so Syme was the most remarkable surgeon. 
 
 Unlik-e his adventurous friend, who tramped a 
 pilgrimage through Europe, James Syme was 
 rooted to his earliest associations. Born in Edin- 
 burgh, he reaped his fame in Edinburgh and died 
 in Edinburgh. He was, as has been said, the 
 peer of surgery in his day. Throughout the king- 
 dom, and probably throughout Europe, there was 
 not his equal. And when one says he was the 
 
 38 
 
Lister and James Syme 
 
 finest surgeon, one also sayis that he was a man 
 of fine quality. In these days, when surgery 
 has so many conveniences, the personal character 
 of the surgeon, though playing a part, is not so 
 dominant as it was in the dajre of James Syme. 
 Then it was all -important, and James Syme's 
 character had the qualities which go tO' the 
 making of a surgeon in an eminent degree. It 
 may seem strange to say they are like to those of 
 a skilled moimtaineer. The comparison may 
 appear romantic, and vmdoubtedly the Alpine 
 climber has a more picturesque and exhilarating 
 setting for his qualities of character than has 
 the surgeon. Nevertheless there is a marked 
 resemblance. Both need a combination of 
 caution and daring of the highest degree. Both 
 have to be swift, apt, and cool-headed in sudden 
 dahger. Both have to be quick to discern and 
 pursue small indications of advantage upon which 
 success and even life depends, and once started 
 on a venture, they can rarely turn back. Fear- 
 lessness, firmness, aptness, swiftness, sureness — 
 such are the qualities of the 'great surgeon, espe- 
 cially in the past, and of the great climber. They 
 were the qualities of James Syme. In the words 
 of Dr. John Brown, the author of " Rab and His 
 Friends," and the intimate friend of Syme, he 
 was verax, capax, perspicax, sagax, eflicax, tenax. 
 At the age of twenty-four Syme, when lecturer 
 on anatomy at Edinburgh, performed the opera- 
 tion of amputation through the hip-joint for the 
 first time in Scotland. Only a medical man 
 
 39 
 
Lord Lister 
 
 can fully appreciate what such an operation then 
 meant . I,t meant a terrific loss oif blood, a greater 
 collapse, and an imminent danger of the death 
 of the patient under the knife. The living being 
 placed under the surgeon's care and submitting to 
 the trial upon his advice, was sure to skirt the 
 borders of death, and would in a few minutes 
 after he had placed himself under the knjfe, 
 quivering and conscious— for then there was no 
 chloroform— moan, grow pale and yet paler, with 
 white lips and beaded brow, imtil the grey of 
 death perhaps crept into the blanched face. A 
 great operation must have been an appalling trial 
 to any surgeon in those days, and still more to 
 a young surgeon. Yet under the eyes of his 
 seniors, with a magnificent confidence in his own 
 complete familiarity with anatomy and his iron 
 nerve, young Syme dared " the greatest and 
 bloodiest operation in surgery," for the first time 
 —that is to say, without having seen or assisted at 
 the operation previously. He was successful, and 
 from that time his name as a surgeon was 
 established. He passed from this operation to 
 many feats that were probably, the most hazardous 
 that any one man has dared, and dared success- 
 fully, upon the living bodies of other men. 
 
 Syme was more than a great operating sur- 
 geon. In his all-round quality only one surgeon 
 is said to have surpassed him, the great John 
 Hunter. He was an able diagnostician, a prac- 
 tical discoverer— amongst other things inventing 
 
 the substance now known as mackintosh— a good 
 
 40 
 
Lister and James Syme 
 
 writer, and a brilliant teacher. His fame as a 
 teacher was as great as his fame as a surgeon, 
 and his classes were more crowded than any in 
 the kingdom. 
 
 In his private character Syme naturally ex- 
 hibited the same qualities as made him a great 
 surgeon. In all things he was essentially a man 
 of power. He was the host and friend in his 
 home and the warrior without. He was large- 
 hearted, hospitable, and upright, staunch as a 
 friend and as a fighter in defence of his friends 
 and what he held to be right. He was a doughty 
 opponent, and the ablest men of his day hesi- 
 tated in controversy if they thought James Syme 
 might take the field against them. His gener- 
 osity enabled him to recognize and acknowledge 
 the work of younger men, a quality by no means 
 common amongst men of fame and experienced 
 years, and as a consequence he always had a 
 devoted following from amongst the yoimger 
 generations . 
 
 Lister was sent by Sharpey to see SjTue in 
 1852, when the latter was at the height of his 
 fame. The visit was not intended to be a lasting 
 one, but as often happens when great natures 
 meet, mutual attraction was immediately felt. 
 Syme, with his strong face, the broad, practical 
 forehead, the firm nose, and the large, generous 
 but rather pugnacious mouth, was attracted to 
 the young surgeon with the calm, meditative 
 face and lofty brow, and the young man quickly 
 learned to revere and love the great surgeon. 
 
 41 
 
Lord Lister 
 
 It was arranged that Lister, instead of returning 
 to London, should stay in the Scotch capital 
 and become Syme's house-surgeon in the Edin- 
 burgh Infirmary, an arrangement that eventually 
 extended Lister's temporary visit to the north to 
 a period of twenty -five years. 
 
 The hospitality of " Millbank," Syme's beau- 
 tiful home on the outskirts of Edinburgh, was 
 thrown open to him. The gatherings at " Mill- 
 bank " were not large, but guests were welcomed 
 with great warmth of heart. In addition to Sylne, 
 the family was formed by his second wife, his 
 three children by her, and his two daughters, 
 Agnes and Lucy, by his previous marriage. With 
 Agnes young Lister fell in love, and his affection 
 was returned. They became engaged, and on 
 April 23, 1856, were married at "Millbank." 
 Up to the time of his marriage Lister adhered to 
 the Society of Friends, but upon his marriage 
 he decided to join the denomination of his wife 
 and became a member of the Church of England. 
 He " married out " according to the phrase of 
 the Quakers. 
 
 The union was childless, and it seems a grave 
 misfortune that Lister and his wife had no child 
 in view of the fine quality there was on either 
 side. But if the union was childless, in all else 
 it was most happy. Their marriage, said a friend 
 of them both, " was a lifelong honeymoon." 
 From the first Agnes Lister was the mother of 
 her husband's labour and of its fruits. As 
 Herschel's faithful sister sat by her brother's 
 
 42 
 
Lister and James Syme 
 
 side hour after hour and carefully noted down 
 what he observed, so Agnes sat by her husband's 
 side and took down the accounts he gave her of 
 his observations. These notes, written in her 
 close handwriting, bear testimony to many a quiet 
 hour of mutual work and mutual affection. 
 
 These days of early marriage were the happiest 
 of Lister's happy life. The shyness and restraint 
 which he always felt with those with whom he 
 was not intimate wore off now that he had his 
 own home in Edinburgh. He now felt free to 
 display amongst his friends the boyishness which 
 he preserved and carried into maturer years, a 
 characteristic of constructive genius, which does 
 not seem to be limited by age but early possesses 
 the gravity of years, but at times of recreation 
 and joy never loses the fresh gaiety of childhood. 
 Not that Lister previous to his marriage had been 
 lacking in high spirits. He joined his friends 
 in the usual adventures of student life ; on one 
 occasion sallying forth to take down the flaunting 
 wooden board of a quack doctor and returning 
 to burn it with ceremony before the Infirmary ; 
 on another climbing " Cat's Nick," being pre- 
 cipitated with his friends to the bottom, and when 
 borne back disabled to the infirmary, receiving 
 the greeting from Mrs. Porter, Syme's famous 
 nurse, " I aye kent something would happen wi' 
 you Englishmen whustlin' on the Sabbath day." 
 But with his marriage his happiness became a 
 permanent factor of his life and his daily 
 possession . 
 
 43 
 
Lord Lister 
 
 Lister and his wife set up house in No. 1 1, 
 Rutland Street, a street opening out of the 
 western end of Princes Street. Besides enter- 
 taining their friends at their own house, the young 
 couple met at " Millbank " Dr. John Brown, 
 Robert and David Christison and other well- 
 known or coming men, and not infrequently 
 foreign surgeons of distinction who came to see 
 Syme's work. The evenings were spent in a 
 family manner, with games, conversation, and 
 music. Lister, who was fond of music and had 
 a good voice, used to sing Scotch songs, his 
 favourite being " Jock o' Hazeldean." But he 
 was in no way a musician and probably never 
 went of his own free will to a concert in his life. 
 Nor had the theatre attractions for him. He 
 had within himself ample entertainment, and 
 divided his time between his work in the world 
 and the pleasures of his home. 
 
 Lister acted as Syme's house-surgeon up to 
 1855, and gathered knowledge and was inspired 
 by the example of his chief. There are several 
 accounts of the daring operations which Syme 
 successfully undertook with the help of his house- 
 surgeon. The effect of these operations upon 
 the junior participant were permanent and fructi- 
 fying. There are, indeed, few things more en- 
 couraging to aspiring youth than a strong and 
 talented master, few things more dispiriting than 
 a pretentious and timorous one. Lister saw sur- 
 gery under the best aspects, and to his trained 
 mind the daring and success of one of Syme's 
 
 44 
 
Lister and James Syme 
 
 most historic operations must have vividly shown 
 that enthusiasm and practice could only be 
 welded together by boldness and decision if they 
 are to achieve supreme success. The occasion 
 was the cure of an aneurism, a condition which 
 holds over the sufferer the probability of an 
 unheralded and immediate death from sudden 
 haemorrhage. 
 
 The case was one of those dramas in which a 
 doctor frequently plays a decisive part. In a 
 brawl a young man had been stabbed in the 
 neck by his enemy. The knife had wounded 
 but not severed one of the carotid arteries which 
 run up on either side of the neck to supply the 
 head and brain with blood. As a result the 
 blood was leaking into the muscles and tissues 
 round and about the artery. In such cases the 
 blood-leakage may suddenly become acute and 
 the patient bleed quickly to death into his own 
 tissues. In this case another fatal sequel was 
 occurring. The blood was slowly collecting 
 round the youth's windpipe and as slowly 
 throttling him to death. In the event of death 
 his assailant would be deemed a murderer and 
 be hanged. Two lives, then, depended upon the 
 slow, progressive leakage from the wotmded 
 artery. 
 
 The wounded youth was brought toi Syme, 
 and he, in spite of the extreme danger of the 
 operation, decided to attempt by his skill to 
 save both the patient and his assailant. Lister 
 assisted him at the operation. Well-known sur- 
 
 45 
 
Lord Lister 
 
 geons gathered round to watch him and students 
 crowded into the theatre. There was that 
 hushed but eager agitation that precedes a daring 
 venture against death. Syme and his assistants 
 got ready. The patient was put under chloro- 
 form. Doctors and students craned forward for 
 a view. On every face there was written the 
 anxiety and dread which leavens all curiosity. 
 Only Syme himself looked cool and unconcerned. 
 Lister was already beginning to perspire, his 
 usual habit at an operation. The patient was 
 " under," the anaesthetist told the surgeon. The 
 patient's shoulders were elevated, and the neck 
 pulled back. Syme and Lister prepared them- 
 selves to be instant in execution. Everything 
 was ready— the knife, the aneurism needle, the 
 sponges. The blood-vessel Syme had to cut 
 into is one of the largest in the body. A few 
 seconds of blood-rush from it and all is over. 
 Next to it lies the big jugular vein of the neck. 
 Nature has protected them with rib and collar- 
 bone. They are hard to get at, and the oozing 
 blood had embedded them in a semi-liquid mass, 
 pushed them aside and confused the few leading 
 marks in this small and bone -encased corner of 
 the body. Syme took the knife and deliberately 
 traced a long line, dividing the skin. The knife 
 was followed by welling blood. Syme then cut 
 swiftly towards the injured artery. Only he and 
 Lister could see. The others attempted to see. 
 AH they saw was gouts of blood spouting and 
 welling from the wound, and the surgeon's and 
 
 46 
 
Lister and James Syme 
 
 assistant's quick fingers at work. What was 
 happening they could not tell. Only the blood 
 poured out. A few moments and it must have 
 been over. The difificulties were tremendous. 
 Syme declared later that they were almost insur- 
 mountable ; he could not think about them with- 
 out a shudder of horror. But it was no time 
 for horror now, but only fbr rapid, decisive work. 
 The patient's face was ghastly in its whiteness. 
 Syme's fingers dipped into the wound, a blunt 
 needle armed with a piece of silk followed them, 
 something was done in the small and deep cavity. 
 More blood gushed forth. The spectators felt a 
 gasping dread that in a moment the final, horrible 
 grey pallor would come otver the face they 
 watched. But Syme and Lister were still cool, 
 though Lister's face was bathed in perspiration 
 as if he had been running a race. Again the 
 fingers dipped in and were followed by the loaded 
 needle. They were withdrawn. Syme leaned 
 back a little from the wound and took a deeper 
 breath . The spectators saw that the wound was 
 dry, the blood no longer spouted and welled 
 from it. Syme had succeeded. The patient was 
 removed. It was too wonderful. All in the 
 still and silent theatre broke out into a prolonged 
 hurrah. 
 
 Lister, as has been said, acquired the greatest 
 admiration for Syme. " I was fascinated by his 
 rare diagnostic power and his surpassing powers 
 as an operator," he said. His father and Sharpey 
 had fixed his love for microscopical research, his 
 
 47 
 
Lord Lister 
 
 father-in-law bound it to the practical aspect 
 of surgery. Upon these two pedestals he firmly 
 took his stand and became the Colossus of sur- 
 gery, beneath whose mighty form we pettier 
 mortals betake ourselves to the art of healing 
 and sail forth from our haven of studentship. 
 
 So well did Syme and Lister suit each other 
 that Lister was given " the unexpected great 
 privilege of a second house-surgeoncy." This 
 appointment lasted until 1855. But the con- 
 nection was not then severed. Lister was 
 appointed assistant surgeon to the infirmary, 
 retaining his connection with Syme and the wards 
 over which the latter ruled. He was also made a 
 Lecturer in Surgery, the course of lectures which 
 he gave qualifying students for the examinations 
 of the University and College of Surgeons. 
 
 Lister was now in a position of authority, but 
 he also had more leisure. Whilst Syme's house- 
 surgeon he had been absorbed by the practice 
 of surgery, and though he had not abandoned 
 the use of the microscope, he had used it mainly 
 to help him in the diagnosis of cases under his 
 care. Now he began once more to attack the 
 problems that provoked him at University College 
 Hospital. At the latter hospital he had searched 
 for fungous bodies as the possible causes of the 
 terrible form of blood-poisoning known as " hos- 
 pital ga,ngrene." This and other forms of blood- 
 poisoning demanded their toll of agony and death 
 at the Edinburgh Infirmary. In London Lister 
 tried forthwith to discover the causes of these 
 
 48 
 
Lister and James Syme 
 
 diseases. With his riper experience at Edin- 
 burgh he began slower and more momentous 
 labours. He laid siege to his problem and no 
 longer trusted to a sudden and happy assault. 
 
 He began to investigate the nature of inflamma- 
 tion as the first step to the solution of the mystery 
 of the putrefaction of the blood which resulted 
 from inflamed wounds. His zeal proved infec- 
 tious, as it is peculiarly liable to do at a medical 
 school amongst students and young graduates 
 concerned with knowledge and as yet unaffected 
 by the need and desire for money. Lister's per- 
 sonal humility and obvious sincerity freed his 
 enthusiasm from any suspicion of arrogance 
 and assertive dominance. Students and young 
 graduates were only too anxious to help him. 
 In abattoirs, in the Veterinary College, in Lister's 
 private house, observations were made and ex- 
 periments carried out. His tirelessness, the tire- 
 lessness that is ever refreshed by the knowledge 
 of its object, sometimes exhausted the volunteers, 
 who were less able than Lister to calculate and 
 weigh the importance of certain experiments and 
 the need of their immediate completion. The 
 late Professor Annandale, one of his helpers, thus 
 recalled his experience : "I confess that on more 
 than one occasion our patience was a little tried 
 by the long hours we 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." 
 One thinks again of Herschel, working at his 
 
 49 D 
 
Lord Lister 
 
 mirror for hour after hour with insuperable 
 patience, whilst his sister put food into his mouth. 
 
 Lister and his assistants were amply repaid by 
 the results of their work. 
 
 The subject of inflammation was beset with 
 difficulties and confusion, a number of theories 
 having gathered about it, as clouds gather about 
 a mountain peak. Lister by his beautiful ex- 
 periments and intuition swept the clouds of 
 misunderstanding away and made the problem 
 lucidly reveal itself. 
 
 The explanation that he gave may sound 
 simple and natural to the lay reader. It is right 
 that it should seem so, for it was both simple and 
 natural. It is one of the duties and signs of 
 genius to reduce the complicated to the simple 
 and resolve the fantastical in the natural. 
 
 Every one knows what happens in inflam- 
 mation ; if not, a very simple experiment will 
 show him. Let him touch his skin with some 
 irritant such as a glowing match -head. At the 
 moment of the touching the skin will be seen to 
 go white, but it will quickly become pink or red, 
 and even if the burn is a very moderate one some 
 redness will remain which cannot be pressed 
 away. If the burn is an unintentional and serious 
 one, blisters will follow and will discharge a 
 clear fluid, and finally in a few days suppuration 
 will take place, matter will be discharged, and 
 some fever and other signs of blood-poisoning 
 will occur, especially if any " dirt " has got into 
 the wound. 
 
 SO 
 
Lister and James Syme 
 
 Such is the course of inflammation 35 presented 
 to the eye. Lister's first problem was to discoiver 
 the how and why of it, or at least to reduce the 
 problem to its first principles and simplest terms. 
 
 The question was one of the highest philo- 
 sophic importance. One may, in fact, state that 
 though this question did not and does not loom 
 large in the public eye, though it did not and 
 has not aroused anything approaching to the 
 sensation caused by Darwin's hypothesis, by the 
 theory of evolution and the apish ancestry of 
 man, their lies secreted in it truths of far greater 
 moment to the fate and happiness of mankind. 
 It ushered in the direct study of the condition 
 described by the name of "vitality," and, turning 
 from the endless and apparently hopeless study 
 of the metaphysics of the mind or ^v^q, initiated 
 the very hopeful study of the metapjiysics of the 
 body. At first, of course, the full significance 
 of Lister's work and aim did not occur to him 
 and his helpers, nor have we yet realized it ; 
 but the astonishing transfer of power from the 
 priest to the physician and the foreshowing of 
 the physician-priest that has occurred in the last 
 decades, may in the end prove to be the unique 
 and outstanding feature of the latter part of 
 the nineteenth and earlier part of the twentieth 
 centuries . 
 
 Lister carried out his experiments at abattoirs 
 and in his own home upon various animals either 
 after they were dead or when they were chloro- 
 formed, or, in the case of the frog, when it had 
 
 51 
 
Lord Lister 
 
 been deprived of sensation by being " pithed." 
 Sheep, horses, oxen, rabbits, cats, bats, and frogs 
 were the subjects of his experiments, but not 
 in any great numbers as the somewhat formidable 
 catalogue seems to show. Of the edible animals 
 far more were killed during his lifetime for his 
 consumption than by his experiments, and in 
 the former case by men much less gentle in their 
 feeling for animals than he. Without these ex- 
 periments he would never have been led to his 
 discoveries. Vivisection, he averred before the 
 Royal Commission upon vivisection which sat 
 in 1876, had been essential to him. 
 
 He found, by watching with the naked eye 
 and the microscope, that what happened after 
 something irritating had been applied to living 
 tissues which did not kill them outright was : 
 Firstly the blood-vessels contracted and their 
 lumen became very small ; the part became pale . 
 Secondly, the vessels after an interval, dilated ; 
 the part became red. Thirdly, some of the blood 
 in the most injured blood-vessels slowed down 
 in its flow and coagulated; redness occurred 
 which, being solid, could not be pressed away. 
 Lastly, the fluid of the blood passed through the 
 vessel walls and formed a " blister " about the 
 seat of injury. 
 
 Why and how did the vessels contract and 
 dilate ? Lister here made , use of the work 
 he had carried out upon the iris of the 
 eye and the phenomenon of goose-skin when 
 he was at University College. He found 
 
 52 
 
Lister and James Syme 
 
 that each tiny artery was surrounded by a 
 muscle similar to that in the iris of the eye, 
 which enables it to contract and dilate. He 
 found further that this contraction and dilation 
 was not an individual act on its part, but was 
 an act dictated to it by the nervous cells in thie 
 spinal cord, the agents of van Helmont's central 
 archaeus.' As a consequence the flush of redness 
 was not strictly localized to the seat of irritation, 
 but would spread over a much larger area, as 
 any one with a bloodshot eye, due to a piece of 
 embedded grit, knows. 
 
 Having proved by a series of beautiful experi- 
 ments and arguments drawn from them the 
 nature of the inflammatory pallor and subsequent 
 flush, and shown them to be dependent upon the 
 central archasus in the nervous system. Lister 
 then set himself to solve or refer back to its 
 first sources the coagulation of the blood that 
 occurred in injured vessels. The experiments by 
 which he solved this problem are yet more fasci- 
 nating and ingenious than the first series, and his 
 accounts of them form some of the few delightful 
 essays in the dry literature of medical research. 
 
 He did not merely solve the problem per se, 
 but he showed that its first principle was the same 
 that accounted for a number of other phenomena . 
 He found that the clotting of the blood resulted 
 from a direct and local loss of the vitality of the 
 cells forming the inner lining of the blood-vessel . 
 He traced it directly to the quality of the life or 
 ' See Introduction. 
 S3 
 
Lord Lister 
 
 vitality they possessed, the condition of the local 
 archasus of van Helmont. This result, expressed 
 in a popular word .such as " debility," which is 
 now taking the popular place of " acidity," " loss 
 of tone," etc., of the chemists and mechanists, may 
 appear to be an anticlimax. But it is not so ; for 
 scientists, like metaphysicians, theologians, phil- 
 osophers, and also the man in the street, are per- 
 petually getting away from that final cause and 
 measure of things, the quality of the life or living 
 thing expressed in the term " vitality." 
 
 Lister's genius preserved him from all stum- 
 bling. The frog, as many know, has the power 
 of becoming dark in a dark place and light in 
 a light place, changing the diffusion of the pig- 
 ment in its skin, which makes it dark, to a con- 
 centration, which makes it light, with a facility 
 that rivals that of the more famous chameleon. 
 Lister for many an hour watched these changes 
 with his microscope in the thin web of a frog's 
 foot. He found by various experiments that 
 this movement of pigment in the deep layers of 
 the frog's skin depended not only upon the 
 nerves or central archseus, but also upon the 
 local. If he irritated or injured the pigmented 
 skin, it lost its vital power for a longer or shorter 
 period, being unable in this paralysed condition 
 to change its hue. For the time being, as it 
 were, the shadow of death had fallen upon the 
 injured web. 
 
 Lister showed how the pigment itself possessed 
 the vital capacity of moving to and fro to effect 
 
 54 
 
Lister and James Syme 
 
 the change of hue which, by making the frog 
 of the same hue as his surroundings, conceals 
 that defenceless animal from his enemies ; and 
 he showed that a great number of different sub- 
 stances, when applied to the skin, brought about 
 the same local paralysis, evidenced by the pigi- 
 ment remaining still under the microscope. 
 Lister then went on to show how the delicate 
 and continuous movement of the minute hairs, 
 or cilia, which coat the frog's tongue was also 
 paralysed, either temporarily or permanently, by 
 the application of irritants. 
 
 Armed with these and other proofs of the 
 fundamental importance of the degree of vitality 
 of the individual cells which collectively form the 
 tissues and organs of a living creature. Lister 
 showed that the clotting of the blood which 
 precedes suppuration and gangrene was due to 
 an actual loss of vitality of the inner cells of the 
 blood-vessel. He showed in the most convincing 
 and beautiful manner that the blood did not clot 
 when in contact with living cells in a good state 
 of vitality, whether it coursed through the blood- 
 vessels or was kept still in them by ligatures tied 
 round an artery or lay free amidst living and 
 uninjured tissues. In the several phenomena of 
 the clotting of the blood, the paralysis of the 
 pigment in a frog's skin and the cilia coating its 
 tongue. Lister saw primarily the same loss of 
 local vitality. He had reached a first principle 
 unencumbered or obscured by the hypotheses, 
 facts, and pseudo -facts of the chemical and 
 
 55 
 
Lord Lister 
 
 mechanical theorists. He saw, as he put it in 
 his own words, " the operation of the mysterious 
 but potent forces peculiar to the tissues of living 
 beings, forces which I suspect will never be 
 fully comprehended by man in the present state 
 of existence, and the study of which should 
 always be approached with reverence and 
 humility." It mattered not what animal or what 
 tissue was attacked, or by what irritant it was 
 attacked. Lister used " mechanical violence, the 
 galvanic shock, desiccation of the tissues, dry 
 heat, warm water at ioo° Fahr., intense cold, 
 caustic ammonia, a strong solution of common 
 salt, carbonic acid, acetic acid, tincture of iodine, 
 chloroform, oil of turpentine, mustard, tincture of 
 cantharides, and croton-oil." In all cases a 
 temporary or permanent loss of vitality of the 
 irritated tissues resulted, evidenced by their loss 
 of function. Disease— that is to say, paralysis of 
 the cells, as the shadow of death— or death itself 
 resulted. The paralysis, moreover, was due in 
 each case to local injury, the paralysis of the 
 local archasus, and had nothing to do with the 
 nervous system, for it also happened when the 
 nervous system was separated from the tissues 
 by cutting through the nerves. " It appears," 
 said Lister in a paper read before the Royal 
 Society in 1857, "that the various physical and 
 chemical agents which, when operating power- 
 fully, extinguish the life of the constituents of the 
 animal body, produce by a somewhat gentler 
 action a condition bordering upon the loss of 
 
 56 
 
Lister and James Syme 
 
 vitality, but quite distinct from it, in which the 
 tissues are, for the time being, incapacitated for 
 discharging their wonted offices, though retaining 
 the faculty of returning afterwards, by virtue of 
 their own inherent powers, to their former state 
 of activity, provided the irritation has not been 
 too severe or too protracted. This suspension 
 of function or temporary abolition of vital energy 
 is the primary lesion in inflammatory congestion." 
 One sees in this description of the philosophy 
 of inflammation upon a small scale a description 
 applying to disease upon a large scale, in which 
 sufferers are " for the time being incapacitated 
 for discharging their wonted offices." One sees 
 that the question of disease in the great class of 
 inflammatory disease at least becomes initially 
 a question of a paralysed vitality. A continuation 
 of such paralysis meant death. Inflammatory 
 symptoms were the signs of bodily resistance 
 to the irritant with promise of recovery. The 
 irritants of which Lister made use in his experi- 
 ments were all dead substances ; the attacks 
 upon vitality were artificial. How would it be if 
 a living, minute, microbic enemy were discovered, 
 whose attacks would vary, as everything that is 
 living varies, and sometimes be long and pro- 
 tracted, sometimes suddenly fierce, sometimes 
 slow but with outbreaks of ferocity ? What vicis- 
 situdes, what drama would be added, were the 
 watching of artificial battles replaced by an out- 
 look upon real warfare between antagonistic life ? 
 What vistas of new understanding would open 
 
 57 
 
Lord Lister 
 
 out of this microscopical warfare with the initial 
 paralysis passing on to death or to a resistance 
 of the tissues as evidenced by inflammation, a 
 warfare which is so vital to man ! What new 
 weapons would be forged, what new defences 
 erected, what new strategy and tactics devised I 
 One general at least was ripe, and probably only 
 one, for these new discoveries. He had himself 
 revealed and seen the process of this warfare 
 in artifice, its local effects and tactics and their 
 differentiation from the central strategy. He was 
 versed in it as no other was versed in it. 
 Through long hours of experiment and the patient 
 watching of affronted Nature, he had become 
 master of the signs of her affliction. The dis- 
 closure of the living enemy would change artifice 
 to reality, and transfer the stage of Lister's 
 generalship from the laboratory to the living 
 world of men. 
 
 It is the ability of genius that rescues " petty 
 mortals " from the labyrinth of confusion in 
 which they involve themselves in attempting to 
 solve or even to find a safe path through the 
 mysteries and difficulties of life. Genius makes 
 the tortuous path straight and the complex 
 simple. Lister made the problem of inflamma- 
 tion seem simple enough. He placed it on a par 
 with the ordinary experiences of life, such as 
 the unexpected attack of an enemy upon the 
 vitality of a coimtry. But the problem was by 
 no means simple before he made it his own. 
 Scientists are apt to be thought by laymen to be 
 
 58 
 
Lister and James Syme 
 
 folk who proceed by the direct proof of experi- 
 mentation, and who never deviate from this safe 
 guide. Nevertheless, in one sense at least, the 
 processes of science differ little from other human 
 processes. They and their results and effects 
 upon the simi of human happiness and power 
 ultimately depend on the unerring aim of genius 
 at the vital centre of all problems. Scientists 
 are as apt as other men to get involved in con- 
 fusion and redimdancy. Any one versed in the 
 science of the present day, and especially in 
 sciences such as psychology^ which as yet has 
 produced no genius, can have little doubt of 
 this. Theories come and go, facts are scarcely 
 established before they are disproved or " quali- 
 fied," speculations and fantasies breed rapidly 
 to a general confusion. A law is scarcely formed 
 before it is found to fail. As a result oif the 
 enthusiastic energy of more ordinary men, un- 
 controlled and unchecked by genius, problems 
 become overgrown, shapeless, and tmwieldy. 
 Then the hand of genius appears and gives 
 shape to the shapeless, and out of the chaos 
 brings form and understanding. Science, the 
 product of great numbers of ordinary men or 
 men of talent without genius, is to-day in its 
 principles and fundamental thought cumbersome, 
 complicated, and confused. But in this matter 
 of inflammation and the reaction of living tissue 
 to attack there is clarity and definiteness, anid 
 this clarity is due to the masterly vision of Lister. 
 Such being the case, it cannot surprise one that 
 
 59 
 
Lord Lister 
 
 sometimes genius becomes impatient of the well- 
 meaning but ill -directed efforts of lesser men, 
 or scornful of the lack of vision by which they 
 miss altogether the obvious that seems to stand 
 in their path. Lister himself, though gentle and 
 patient to a rare 'degree, sometimes gives evidence 
 of this scorn, which in his case, perhaps, was 
 more in the nature of surprise, for he was one 
 who had a faith in man's efficiency and devout 
 truthfulness not altogether warranted. "It may 
 appear almost incredible," he wrote in one of 
 his papers of this period, " that a fact of such 
 fundamental importance, and at the same time 
 so easy of demonstration should have escaped 
 the observation of all the eminent men who have 
 made the coagulation of the blood a subject of 
 special study " ; and again : " This remarkable 
 phenomenon, though of itself clear proof of an 
 alteration in the properties of the blood in an 
 irritated part, has, strangely enough, attracted 
 little attention from other observers." But such 
 expressions of impatience or surprise are rare 
 in his papers. They are infused rather by a 
 noble reverence for his subject and a profound 
 meditation upon the secrets that lie hid in 
 phenomena we deem to be familiar, the blush 
 that follows a blow and the lasting stain of a 
 bruise. 
 
 A photo of him taken at this time, when he 
 was about thirty years of age, repeats the 
 character of his writing. He is sitting upon a 
 chair, his knees crossed, his arms folded, his 
 
 60 
 
Lister and James Syme 
 
 face in three-quarter profile. The attitude is 
 one in which the Umbs are composed so that the 
 thought may be free. The face of Lister is 
 eminently one of thought. The features are 
 refined and geijtle, the eyes quietly contemplative, 
 without any of the fire of the fanatic. It is the 
 brow that is most impressive. It is both broad 
 and high, overhanging the eyes with its dome 
 of thought. It is smooth and without line, and 
 gives to the calm face the serenity of a noble 
 meditation, that is not vexed by ambition or 
 fretted by resentment. It is, indeed, a face such 
 as the people of the Orient deem has sacred 
 quality within it, in the serene mastery and calm 
 which appears to them the summit of man's 
 attainment . 
 
 At the end of 1859 Mr. James Lawrie, the 
 Professor of Clinical Surgery in the University 
 of Glasgow, died. In February, i860. Lister, 
 owing to his own merit and the strong advocacy 
 of his father-in-law, was appointed to be his 
 successor. In the same year he was made a 
 Fellow of the Royal Society for his work upon 
 inflammation. He was thirty -three years of age 
 at the time. 
 
 The position of Professor of Surgery at 
 Glasgow was peculiar. It did not carry with 
 it an appointment as surgeon to the Glasgow 
 Infirmary, which was separate from the Univer- 
 sity. The allotment of surgical wards to the 
 care of the Professor of Surgery depended upon 
 the goodwill of the directors of the infirmary. 
 
 61 
 
Lord Lister 
 
 In Lister's case the directors proceeded with 
 the caution for which Scotchmen are famed. 
 They spent a year ruminating upon the merits and 
 demerits of the young professor. The honour 
 which the Royal Society had paid to him and 
 a petition signed by a large number of students 
 crystallized their decision. After a delay of 
 twelve months they appointed to their hospital 
 the young surgeon who was destined to make 
 its wards the scene of one of the greatest 
 triumphs of mankind. 
 
 The surgical wards of the Glasgow Infirmary 
 at this time were hotbeds of pollution and 
 disease. But in this they did not differ from 
 those of other hospitals, as the next chapter will 
 disclose. ' 
 
 62 
 
CHAPTER III 
 
 THE DEFEAT OF CHARITY 
 
 The charity of men within the records of history 
 has always made some provision for the sick. 
 In Greece and Egypt the temples of the gods 
 were also places of refuge for the sick, and^ 
 in addition to these sacred and therapeutical 
 resorts, physicians were publicly appointed to 
 attend to the poor. 
 
 The first widespread hospital system— not only 
 for men but for animals also— which is com- 
 parable to the modern system was established 
 by King Asoka (260 B.C.), the famous Buddhist 
 sovereign of India. 
 
 The Romans followed the example of the 
 Greeks and appointed public physicians and dis- 
 pensaries. Christianity, like Buddhism, inspired 
 charity with increased fervour, and hospitals 
 spread over the Christianized Roman Empire. 
 These institutions were, however, more eccle- 
 siastical than medical ; the clergy and the charit- 
 able of the congregation figured importantly, and 
 the physician and student of medicine were of no 
 account. Thus a law of the Emperor Honorius 
 mentions six hundred nurses who were placed, not 
 
 63 
 
Lord Lister 
 
 at the disposal of the physicians but of the bishop, 
 for the care of the sick in the hospitals at 
 Alexandria. 
 
 The followers of Mohammed established in 
 their empire far more efficient hospitals, in which 
 the sick were housed and nursed, and were 
 attended gratuitously by physicians who them- 
 selves had students under their charge. Bagdad, 
 Damascus, Jerusalem, Cairo, Alexandria, Cor- 
 dova, all the cities of the Arabian Empire pos- 
 sessed well -equipped hospitals under the control 
 of expert physicians. In Bagdad, in the twelfth 
 century, there were no less than sixty salaried 
 physicians upon the staffs of the city hospitals. 
 
 The efficiency of the Mohammedan medical 
 charities began to shame the ecclesiastical 
 charities of the Christians. The crusaders 
 brought back stories of the magnificence of the 
 hospitals of the, East and the skilful treatment of 
 their physicians which they had themselves ex- 
 perienced. Travellers from Spain brought the 
 same tales. For a time Christendom was stimu- 
 lated to more proper efforts, and the physician 
 and his worldly art gained some respect. 
 
 But as the Arabian influence died away, the 
 Christian hospitals, whose inefficiency was un- 
 deniable, became again neglected. Funds were 
 misappropriated, buildings fell into decay, and 
 though benevolence did what it could, the pre- 
 vailing reverence for the priest and the contempt 
 of the physician who attended to the despised 
 body prevented a capable service. 
 
 64 
 
The Defeat of Charity 
 
 It was in 1574, in the starved and battered 
 city of L'eyden, that the medical art once more 
 regained respect. There, after the fiercest siege 
 in modern history, the forces of Protestantism 
 for the first time clearly triumphed over those of 
 Catholicism, and to crown the triumph the 
 University of Leyden was founded. Professors 
 were nominated, amidst whom those of the 
 medical faculty took an honourable place. On 
 the day of the opening ceremony, upon February 
 5j I575j symbolic figures were drawn through 
 the flower-strewn streets of the recovering city. 
 There Were four groups : the Gospel, Justice, 
 Medicine, and Minerva. With the Goddess of 
 Medicine rode Hippocrates, Galen, and other 
 physicians. With Minerva rode Aristotle, Plato, 
 Cicero, and Virgil. Once more knowledge was 
 united to the charity of the gospel. Apollo and 
 the nine Muses enthroned awaited the professors 
 and embraced them each in turn. The procession 
 then marched to the cloister of St. Barbara, 
 converted into the University of Leyden, and 
 there the blessing of God was called down to 
 give power to the rebirth of knowledge. 
 
 But many years passed before the religious 
 struggles of the Reformation died down and 
 enabled men to pay heed to the new schools 
 of learning and hospitals. In Catholic countries 
 the priests still ruled over hospitals and the 
 orphanages and almshouses connected with them. 
 
 The notes of John Howard the philanthropist, 
 who wrote in 1789, give a picture of the 
 
 65 E 
 
Lord Lister 
 
 European hospitals of his time. They were 
 mostly very crowded and at times of epidemic 
 sickness the crowding was terrible. In the 
 Hdtel Dieu in Paris, for example, there were 
 1,200 beds and an average of 3,000 patients, 
 the number at times of epidemic mounting to 
 7,000. There were two patients in one bed, and 
 often more. Medical and surgical sufferers were 
 mixed together, a man with a broken leg being 
 in bed with a man with fever, or a convalescent 
 and a dying man side by side. Windows were 
 kept closed, fresh air being regarded as dan- 
 gerous. "The wards were often so offensive," 
 wrote Howard, "as to create the necessity of 
 perfuming them ; and yet I observed that the 
 physician, in going his roimds, was obliged to 
 keep his handkerchief to his nose." Of the 
 British hospitals Howard gave a better account, 
 though he had no praise for the Edinburgh 
 Infirmary. The London hospitals, he com- 
 plained, were actually too free from ecclesiastical 
 influence, for he " never found any clergyman 
 administering consolation and admonition to the 
 sick." 
 
 The sickening odour of the wards of hospitals, 
 of which Howard complained, continued to exist 
 up to the days of Lister. There was, said Sir 
 Hector Cameron, Lister's house-surgeon in the 
 Glasgow Infirmary, " in the atmosphere of every 
 surgical ward, no matter how well ventilated, 
 a foetid, sickening odour, which tried the student 
 on his first introduction to surgical work just 
 
 66 
 
The Defeat of Charity 
 
 as much as the unaccustomed sight of the 
 operating theatre." 
 
 •What, then, was it which made these pre -Lister 
 hospitals such offensive places that only perfume 
 could deceive the sense of smell as to the horrors 
 which only the eyes of familiarity could witness 
 without shuddering? What was it that made 
 the wounds and injuries of men, women, and 
 children under the tendence of charity so in- 
 comparably more loathsome than the wounds 
 of animals and less civilized men, so that it not 
 only seemed but actually was the case that the 
 charity of man was defeated and turned into a 
 source of untold agony and suffering? 
 
 The subject is a gruesome one, but it is 
 indispensable in order that the work of Lister 
 may be properly illuminated. It is indispen- 
 sable also as one of the most dramatic lessons of 
 the danger of charity without understanding, of 
 the tender heart without the governing mind. 
 
 Sir Hector Cameron gave the following brief 
 description of the days when Lister first went to 
 Glasgow : " Every wound discharged pus freely, 
 and putrefactive changes occurred in the dis- 
 charges of all " ; and again : " Secondary 
 hcemorrhage, tetanus, erysipelas, septicaemia, 
 pyaemia, and hospital gangrene were never all 
 absent from the hospital wards, and at times 
 pyaemia and hospital gangrene became alarm- 
 ingly epidemic." The list of technical names 
 can scarcely convey to the mind of the reader 
 the repulsive horror and the sights of agony 
 
 67 
 
Lord Lister 
 
 which Lister so often witnessed and Which stirred 
 so profoundly his earnest and tender nature. In 
 order to give an unadorned and unmodified 
 account of the scenes that could be witnessed in 
 a hospital in those days it is best to quote directly 
 from the most famous textbook of surgery in 
 the first half of the last century, " The Principles 
 of Surgery," a series of discourses by John Bell, 
 and re-edited by his brother, Sir Charles Bell. 
 
 Lister's first work in antisepsis was upon cases 
 of compound fracture — that is to say, cases of 
 broken bone in which the skin is also torn 
 through either by the force of the injury or else 
 by the sharp ends of the broken bone itself. The 
 broken skin offers an opening through which 
 " dirt," or infective germs, can enter and cause 
 putrefaction and blood-poisoning. 
 
 A compound fracture nowadays is scarcely 
 worse than a broken bone without torn skin, 
 unless there is very great crushing and laceration 
 of the bones and tissues. But in the days of 
 John Bell and Lister's early years no accident 
 could well be more serious if the patient had the 
 misfortune to be taken to the hospital. He 
 was better off in the gutter. 
 
 The wound in hospital invariably became in- 
 fected. Infection was rife in the hospital. 
 Every wound poured forth the infective poison, 
 and by the congregation of many sick the poison 
 became more concentrated and deadly. It would 
 be folly to take a child suffering from an ordinary 
 
 sore throat and put him in a hospital ward filled 
 
 68 
 
The Defeat of Charity 
 
 with children sick with virulent diphtheria. It 
 was a far greater folly, though an unconscious 
 one, in those days to take a wounded man to 
 hospital. The injury greatly lowered the vitality 
 of the injured tissues, and in their paralysed con- 
 dition they fell an easy prey to the virulent germs 
 that haunted every surgical ward. Such wounds 
 then always suffered from putrefaction. The 
 following is John Bell's account. It is frankly 
 horrible, and the reader of delicate nerve had 
 better skip it and pass on to page TJ . 
 
 The discourse was headed " Of the Stage of 
 Suppuration," and continues :— 
 
 " Though you expect to procure adhesion, and 
 at least to make some part of the wound adhere, 
 you are often disappointed ; you are sensible 
 from the violence of the fever and the swelling 
 of the limb that mischief is going on within . The 
 dry skin, the parched mouth, the thumping pulse, 
 the restlessness and delirium, continue for some 
 days, and there is a blackness round the wound 
 threatening gangrene. But this fever by degrees 
 becomes less violent, the livor, which proceeded 
 partl))^ from the ecchymosis, partly from the 
 dark colour, of the inflammation, gradually 
 changes to green, the great wound begins to 
 suppurate and open very wide, the whole limb 
 swells to an enormous degree, the skin and 
 cellular substance are soft and relaxed, and bear 
 the impression of the finger, the redness extends 
 all over the limb, and from the particular hollow- 
 ness and softness of certain points you are 
 
 69 
 
Lord Lister 
 
 sensible that great suppurations are forming 
 within. 
 
 " All your prudence, and more especially all 
 your diligence, is required for conducting this 
 stage of the disease. You are careful to dress 
 the limb every morning, and perhaps to clean 
 it a little in the evening. By regular washings 
 and wiping with the moist sponge you prevent 
 those smells which depress the patient's spirits 
 and injure his health, and by laying clean lint to 
 the wounds twice a day you soak up the foul 
 matter. . . . How much is due to care and 
 cleanliness " (really, " how dangerous were the 
 hospitals") "you may judge from this, that in 
 the case of a gentleman who lies in his own 
 house we often venture to save a limb which 
 had the accident befallen a poor man lying in 
 a crowded hospital, must have been cut off. 
 In hospitals, especially in military hospitals, and 
 most of all in hospital ships (which the Lords of 
 the Admiralty would do well to burn), the patient 
 sinks almost inevitably under the suppuration of 
 a compound fracture. 
 
 " Often it happens, from the destruction of 
 the parts or the unhappy circumstances of the 
 patient, that all your cares are unavailing. Every 
 time you examine the limb you make discoveries 
 of more extensive destruction, you find the whole 
 limb swelling more and more, you find the matter 
 running profusely from the openings, the open- 
 ings increasing in number, and the suppurations 
 extending from the ham to the heel with intoler- 
 
 70 
 
The Defeat of Charity 
 
 able fcEtor, the muscles all undermined, and the 
 bones carious. You find that you are no longer 
 able to support the patient's health, that repeated 
 attacks of diarrhoea and fever have reduced him 
 to extreme weakness ; and the wan visage, the 
 pale and flabby flesh, the hollow eyes and the 
 .prominent cheekbones, the staring and squalid 
 hair, the long, bony fingers and crooked nails, 
 the quick, short breathing, and small piping 
 voice, declare the last stage of hectic and 
 debility ; the natural powers are then sunk so 
 low, the appetite for food and even the desire 
 of life so entirely gone, that we would believe 
 the patient past all help did we not know by 
 experience that it is never almost too late to 
 amputate." 
 
 But an amputation always meant renewed 
 suppuration, against which the wearied and 
 emaciated patient made little or no fight. Even 
 if he recovered without an amputation, "he is 
 lame and walks on a stilt, and his natural con- 
 stitution has received an irreparable shock " ; 
 from the state of a healthy man he falls " to 
 the state of a valetudinarian, dispirited and 
 dejected, travelling now the downhill way of 
 life : he has lost his health and saved a limb, 
 which he drags after him with labour and pain." 
 
 It is not surprising, then, in face of this terrible 
 suppuration following upon compound fracture 
 that John Bell and the surgeons of his time 
 recommended the lesser suppurative sickness 
 following amputation to such unfortunates, 
 
 71 
 
Lord Lister 
 
 although this included the operation without 
 chloroform, in which the patient was bound down 
 to the table, whilst with his senses keenly alert 
 his limb was swiftly severed from him. But 
 even after the amputation had been performed 
 the chance of the patient getting out of the 
 hospital alive was little more than an even one. 
 Further suppuration, crippling his health, he was 
 boimd to endure. i 
 
 A more dread foe awaited him or any un«- 
 fortunate who found himself with a wound or 
 had to have an operation in a surgical hospital. 
 He might fall a victim to that ghastly disease 
 which, abolished by Lister, was previously known 
 as " hospital gangrene." There were other forms 
 of blood-poisoning as fatal, but none possessed 
 the peculiar horror of this disease. 
 
 John Bell, in Discourse III, wrote :— 
 " There is no hospital, however small, airy, or 
 well regulated, where this epidemic ulcer is not 
 found at times ; and then no operation dare be 
 performed, every cure stands still, every wound 
 becomes a sore, and every sore is apt to run into 
 gangrene ; but in great hospitals especially it 
 prevails at all times, and is a real gangrene ; it 
 had been named the ' hospital gangrene ' ; and 
 such were its ravages in the Hotel Dieu of Paris 
 (that great storehouse of corruption and disease) 
 that the surgeons did not dare to call it by its 
 true name ; they called it the rottenness, foul- 
 ness, and sloughing of the sore ; the word 
 ' hospital gangrene ' they durst not pronounce, 
 
 72 
 
The Defeat of Charity 
 
 for it sounded like a death-knell ; at the hearing 
 of that ominous word the patients gave them- 
 selves up for lost. In the Hotel Dieu this 
 gangrene raged without intermission for two 
 hundred years, till, of late, under the new 
 Government of France, the hospital has been 
 reformed. ' A young surgeon ' (says an ancient 
 French author) ' who is bred in the Hotel Dieu 
 may learn the various forms of incisions, opera- 
 tions, too, and the manner of dressing wounds ; 
 but the way of curing wounds he cannot learn. 
 Every patient he takes in hand (do what he 
 will) must die of gangrene.' " 
 
 John Bell went on to describe this disease in 
 some sailors under his own care : — 
 
 " While these ulcers made their dreadful pro- 
 gress in any of the wounded I could observe 
 them pass through the several stages — first of 
 inflammation, then of insensibility and gangrene, 
 and then of renewed pain and sensibility. First, 
 when the health is affected, the patient has 
 shiverings, languishes for a few days, and the 
 sore inflames ; then comes vomiting, diarrhoea, 
 and a distinct fever, and the disease seizes plainly 
 on the wounded part. In its first stage the 
 wound swells, the skin retracts, wastes, has a 
 dark erysipelatous redness verging to black, the 
 cellular membrane under the skin is melted down 
 into a foetid mucus, and the fascia is exposed. 
 But in the second stage the fascia and skin, 
 unable to bear their inflammation and deprived 
 of mutual support, become black, foetid, soft, 
 
 73 
 
Lord Lister 
 
 and fall into perfect gangrene ; yet there are no 
 vesicles, and the mortification is confined within 
 the cavity of the sore. This is the stage of 
 insensibility ; the parts within are covered and 
 defended with a perfect slough, which no 
 medicine can penetrate, on which no applica- 
 tions can make any impression ; and stimulants 
 are used, without pain, of such a hot and fiery 
 nature as none but dead parts could resist. But 
 when these sloughs open in the natural course 
 of the disease, and the living parts are exposed, 
 and the medicines begin to make an impres- 
 sion, it is imagined that these applications are 
 restoring life and energy to parts which, before 
 they were applied, seemed entirely dead ! It 
 is under the impression that stimulants are con- 
 tinued of a strength which parts thus inflamed 
 cannot bear ; the disease is aggravated by them, 
 and the cries from all sides are such as would 
 melt the most rugged nature. 
 
 " In the third stage this gangrene ceases, the 
 sloughs fall off, the muscles become exposed, 
 the part assumes once more the appearance of 
 a common sore, but fearfully enlarged ; a high 
 and glossy red and a smooth, shining, uninter- 
 rupted surface mark the continuance of the 
 inflammation and disease ; but if the sores 
 are to do well, it is known by a rough, 
 granulating surface, somewhat dry and of a 
 paler colour. 
 
 " If the patient is to die, the gangrene or 
 wasting of the cellular sheath proceeds ; the skin 
 
 74 
 
The Defeat of Charity 
 
 first sloughs off, then the fascia is destroyed ; 
 those divisions and lamellae of the fascia which 
 dive between the muscles to enclose, protect, and 
 nourish them are next affected ; the matter con- 
 tinues slimy and thick and in prodigious quan- 
 tities ; the muscles are divided from each other 
 more and more. In many who suffered under 
 the disease at the same time with Joiner (the 
 boy above mentioned) you could have laid your 
 hand edgeways betwixt the several muscles of 
 the thigh. Then the vomiting, diarrhoea, and 
 nervous symptoms increase, the pain is dread- 
 ful ; the cries of the sufferers are the same in 
 the night as in the daytime ; they are exhausted 
 in the course of a week and die : or if they 
 survive, and the ulcers continue to eat down 
 and disjoin the muscles, the great vessels are 
 exposed and eroded and they bleed to death. 
 Thus a lad of the name of Handling, who had 
 at first but a slight wound in the thigh, had the 
 cellular membrane in the course of a few days 
 so destroyed that you could put your clenched 
 fist into the hip and could lay the hand sideways 
 betwixt any two muscles of the thigh. You could 
 have counted each muscle as in a dissection, 
 from the tuber ischii to the ham. The branches 
 of the profunda femoris first gave way, then the 
 sciatica vessels ; for three nights he lost two 
 or three pounds of blood each night ; it would 
 have been almost cruel to stop the haemorrhage, 
 had it been possible, so very desperate was his 
 situation ; on the fourth day he died. I hope 
 
 75 
 
Lord Lister 
 
 and believe that these scenes have made a lasting 
 impression on the few who witnesseid them. 
 
 " These are the forms which this disease 
 assumes when it attacks an amputated stump : 
 a broad and open wound, a laceration of the 
 skin or any surface which is apt to become a 
 flat sore. But when it attacks a narrow wound, 
 as a bullet wound, a wound with any pointed 
 instrument, even the prick of a nail in the finger, 
 it assumes at once the form of an erysipelatous 
 gangrene (erysipelas gangrenosa) ; and when 
 this disease prevails in the hospital you may see 
 even a nurse from some slight hurt in the hand, 
 which at another time could have done no harm, 
 have one day a swelling of the wound, on the 
 next an erysipelas of the arm, with dreadful pain 
 and low fever, on the third day the arm will 
 become livid and covered with vesicles, and in 
 two days more fall into gangrene, the woman 
 oppressed in the meanwhile with hiccup, low 
 delirium, and other symptoms of approaching 
 death. 
 
 " The wounds which are most apt to be seized 
 with this hospital gangrene are those which are 
 flat and open, because in them much of the skin 
 has been torn away. Tucker, a boy also belong- 
 ing to the Triumph, who lay in the bed next to 
 Joiner, had, like him, received a superficial and 
 open wound, or a scratch rather, upon the loins 
 from a splinter of wood. This dreadful infection 
 seized upon his wound, and the ulcer extended 
 over the loins, over both buttocks, and part of 
 
 76 
 
The Defeat of Charity 
 
 both thighs ; he could only lie on his belly, 
 and, like Joiner, cried in the most lamentable 
 manner." 
 
 John Bell continued with further pictures of 
 this repulsive and cruel disease. Men, women, 
 and children were turned by it into a foul but 
 living putridity, until death at last got rid of the 
 life that was a burden to itself and a source 
 of offence and loathing to its neighbours. This 
 was the worst disease of the many terrible 
 diseases that were the gift of man's charity to 
 man. It was the gift which the H6tel Dieu, the 
 House of God, dispensed to all who sought or 
 were forced into its charitable wards, so that 
 no less than twenty-five out of every hundred 
 who entered living were borne out dead. In the 
 great hospital at Munich at one time as many 
 as eighty out of every hundred patients with 
 wounds were seized with this dread pestilence. 
 The houses of God and the great hospitals were 
 lies and delusions, the traps of the destructive 
 goodwill of the ignorant. 
 
 What was the remedy against this hideously 
 deceptive charity? 
 
 John Bell continued : — 
 
 "What, then, is the surgeon to do? Is he 
 to try experiments with ointments and plasters 
 while the men are dying around him? Is he 
 to seek for washes and dressings to cure such 
 a disease as this? Is he to expend butts of 
 wine contending, as it were, against the elements ? 
 No ! Let him bear this always in mind, that no 
 
 77 
 
Lord Lister 
 
 dressings have ever been found to stop this ulcer, 
 that no quantities of wine or bark which a man 
 can bear have ever retarded this gangrene ; let 
 him bear in mind that this is a hospital disease, 
 that without the circle of the infected walls the 
 men are safe ; let him, therefore, hurry them out 
 of this house of death ; let him change the wards, 
 let him take possession of some empty house 
 and so carry his patients into good air ; let him 
 lay them in a schoolroom, a church, on a dung- 
 hill, or in a stable ; let him carry them anywhere 
 but to their graves." 
 
 In 1846 the first operation under a general 
 anaesthetic was performed in Boston Hospital, 
 and the following year Sir James Simpson proved 
 and used chloroform. The annihilation of the 
 dreadful pain which made an operation such' a 
 gruesome thing in the past, and forbade any 
 operations but those that were most urgent, 
 opened out an apparently new era for surgery. 
 But in hospitals the new blessing effected its 
 own defeat. More operations were undertaken 
 for lesser troubles, and the dread and terrible 
 diseases of pyaemia and gangrene swept through 
 the wards with redoubled fury. 
 
 Even outside the hospital, where conditions 
 were all that wealth could provide, these deadly 
 diseases sometimes effected an entrance, to the 
 despair of the surgeon, and suppuration after 
 large operations and in cases of large wounds 
 and compound fracture was invariable. Here, 
 too, if a patient escaped death, he was crippled 
 
 78 
 
The Defeat of Charity 
 
 for life. The shadow of death that fell upon 
 him was never wholly lifted. 
 
 Surgery was baulked and baffled, and 
 hospitals, both for patients, nurses, and doctors, 
 were places of living torment, which resounded 
 with the cries of agony and polluted the air 
 with the exhalation of rotting flesh. 
 
 It were better for a man to be placed " on 
 a dunghill or in a stable " than let him remain 
 in the house of charity that his fellow-men had 
 provided for him. 
 
 79 
 
CHAPTER IV 
 
 PERPLEXITY AND ENLIGHTENMENT 
 
 One of Lister's Edinburgh friends and a pupil 
 of James Syme was Dr. John Brown, the 
 gentle and melancholy author of " Rab and His 
 Friends." In that well-known story Ailie, Rab's 
 mistress, was operated upon. At first all went 
 well, but on the fourth day the fatal blood- 
 poisoning began—" a blush of red told the 
 secret." Ailie became worse, and delirium set 
 in. " Nothing more touching, or in a sense 
 more strangely beautiful, did I ever witness. 
 Her tremulous, rapid, affectionate, eager Scotch 
 voice, the swift, aimless, bewildered mind, the 
 baffled utterance, the bright and perilous eye ; 
 some wild words, some household cares, some- 
 thing for James, the names of the dead, Rab 
 called rapidly and in a fremyt' voice." 
 
 Lister did not view the disease with this sen- 
 timental pathos. One thinks he must have read 
 the book of his friend with strange feelings, for 
 these ghastly sicknesses could not be varnished 
 out of their horribleness by a too gentle heart, to 
 which the delirium provoked seemed " strangely 
 
 80 
 
Perplexity and Enlightenment 
 
 beautiful." In Lister they aroused feelings of 
 revolt rather than sentiment, and a rigid deter- 
 mination to overcome them, which was greater 
 than his pity. 
 
 In Glasgow, in 1861, Lister for the first time 
 had full command and responsibility in his wards . 
 Glasgow was then as now a big manufacturing 
 town with a large shipbuilding and shipping 
 trade, with no great reputation for cleanliness 
 but a considerable one for dirt and danger. 
 Accidents were frequent in the shipping yards, 
 and the men to whom these accidents happened 
 were not the brawny sons of the moors and 
 mountains, but the puny sons of the slums. 
 
 Lister also had come from the wards of James 
 Syme, and that great surgeon by his care and 
 cleanliness had succeeded, at least in part, in 
 warding off hospital gangrene and pyaemia. But 
 the wards of the Glasgow Infirmary did not 
 show a similar firm hand. The dominant spirit 
 was not that of the surgeon, but of the lay 
 authorities. We have seen how slow and cautious 
 the authorities had been in their appointment 
 of Lister, and they continued to watch the young 
 professor with a proper suspicion and to direct 
 his ways. Economy of the narrowest kind was 
 to them the light of reason, and a small bill for 
 soap and scrubbing-brushes more commendable 
 than cleanliness. 
 
 The spectacle, therefore, that met Lister in 
 the wards put under his charge, though not un- 
 familiar, was one oppugnant to his sense of 
 
 81 F 
 
Lord Lister 
 
 fitness. The wards, though recently buUt, were 
 dirty, and a general gloom hung about them 
 as if their very appearance had partaken of the 
 dark unhappiness they housed. The spectacle 
 of the patients was yet more depressing. The 
 unfortunate victims of the squalid alleys and 
 factories of Glasgow, when injured or perforcedly 
 submitting to operations, had few powers of 
 resistance to diseases that often fought vic- 
 toriously with the healthiest men. Blood-poison- 
 ing in the forms of pyaemia (blood-poisoning 
 with multiple abscesses), hpspital gangrene, 
 erysipelas, and other foetid diseases were rife. 
 Thirty -nine out of every hundred men who had 
 to submit to amputation died, and in addition 
 to this terrible mortality those who recovered 
 were frequently enfeebled for life. 
 
 To all surgeons and assistants such scenes 
 were so common that they were met in a spirit 
 of stoicism which men rightly assume to that 
 which is inevitable. When outbreaks of gangrene 
 were peculiarly malignant and every effort of 
 the surgeon was finally trumped by death, then 
 in resignation the surgeon would lay down his 
 knife while the scourge endured and listen to 
 the sympathetic assurances of his friends that 
 he was not guilty of what fate inflicted. 
 
 Most fortunately, Lister, with the sense of 
 power his comprehensive and directive intellect 
 gave him, was not willing to submit. His 
 feelings with regard to such absolute failure were 
 original ; they were not fashioned by friendly 
 
 82 
 
Perplexity and Enlightenment 
 
 consolation. He felt ashamed, he said, in draw- 
 ing up his reports, that he had so frequently to 
 record fatal results due to these diseases. He 
 brooded constantly over their meaning and the 
 fMDSsible causes that gave rise to them. He was 
 utterly discontent with submission to their 
 ravages. The thought of mastering them was 
 ever with him and guided his actions, his 
 observations, and inquiry. Why was it that when 
 a limb was broken but the skin remained whole 
 he could expect and promise to his patient a 
 recovery without the horrors and dangers of sup- 
 puration? Why, on the other hand, when the 
 skin was broken, should these impurities inevit- 
 ably arise? He pondered over these things and 
 pointed "k them out to his students as he went his 
 rounds. " I cannot help thinking," he said after 
 such a demonstration, " that the man who is 
 able to explain this problem will gain for 
 himself undying fame." 
 
 The test of greatness is not only the con- 
 centration of the mind upon some great and 
 urgent problem, not only the whole absorption 
 of self in this problem which is attacked without 
 any ulterior motive than that of victory, but also 
 the varied means by which the attack is made. 
 Lister's mind was concentrated upjon his subject. 
 His desire to overcome his problem was free 
 from anjy ulterior motive. He sought primarily 
 neither fame nor remuneration through its pos- 
 sible solution, being quite free from the exploiting 
 spirit. He sought only its solution, and brought 
 
 83 
 
Lord Lister 
 
 all the variety of thought, inquiry, and know- 
 ledge he could command. 
 
 His experiments in inflammation had alto- 
 gether shaken his faith in such theories of putre- 
 faction and suppuration as were then taught to 
 students and believed by the profession. In 
 reading surgical authors of the time one is chiefly 
 struck by the lack of even such imagination as 
 acknowledges that it does not know. One never 
 comes across any author referring to the mystery 
 of these diseases. Medical writers were as in- 
 different to these diseases as mysteries as they 
 are to-day to the extraordinary decay of teeth, 
 the mystery of the selective nature of memory, 
 which plays so notable a part in many nervous 
 and mental diseases, the increase of insanity, the 
 difficulty of child-birth, the prevalence of appen- 
 dicitis, the increased defectiveness of eyesight, 
 and many other medical mysteries that are 
 about us in these times. What Lister searched 
 for in the profession — namely, any philosophic 
 thought as to the causes of these diseases — he 
 could not find. And the reason was that he could 
 not find what was not there. They had no 
 philosophy. Philosophy played no part in their 
 curriculum. It played no part in their research 
 work. It received no recognition from the pro- 
 fession ; it receives none to-day. Even in 
 Scotland, the home of British philosophy, there 
 was no definite recognition of the extraordinary 
 need of, the philosophic mood, if medical 
 problems are properly to be sittacked and 
 remedies rightly valued. 
 
 84 
 
Perplexity and Enlightenment 
 
 The mystery of these loathsome diseases had 
 not even got to the stage of being a mystery and 
 thereby challenging a solution. Only the philo- 
 sophic temperament is not lulled by the familiar, 
 but challenges it as if it were strange. This 
 temperament Lister amongst surgeons of the 
 day alone seemed to possess in a dominant 
 degree. Sir Hector Cameron, in an admirable 
 paper upon Lister read at Toronto in 191 2, 
 emphasized this philosophic possession of his 
 Glasgow chief. He quoted from Cicero the 
 words : " Instead of striving, as we ought, to 
 render ourselves strange to the familiar, we strive, 
 on the contrary, tcr render ourselves familiar with 
 the strange." The question to me, however, 
 does not seem to be one of " ought," but one 
 of the natural differentiation between the genius 
 of the mass of men ; and it is for the nourish- 
 ment and general acknowledgment of the rare 
 capacity of genius, which by its quality has such 
 unrivalled value, that a reverence for philosophy 
 might prove of incalculable benefit to the medical 
 profession. 
 
 However this may be, none will deny that 
 Lister possessed the philosophic temperament in 
 the highest degree. " I am sure," continued Sir 
 Hector, " all those who have been closely asso- 
 ciated with Lister and have watched the working 
 of his mind will appreciate my statement when 
 I say that, more than any man I ever met, he 
 had the power of rendering himself ' strange to 
 the familiar.' ... I once said to him, when 
 
 85 
 
Lord Lister 
 
 we were talking of such matters, that I believed 
 he had a rare power of making himself ' strange 
 to the familiar.' He gave one of those pleased 
 smiles which many of us knew when some remark 
 was made which was not ungrateful to him ; but 
 he did not indicate to me whether he was 
 conscious of possessing any such mental advan- 
 tage." 
 
 " When he was told such a thing must be 
 so," said Matthew Arnold of Goethe, " there 
 is an immense authority and custom in favour 
 of it being so — it has been held to be so for 
 a thousand years," he answers with Olympian 
 politeness, " But is it so ? Is it so to me ? " 
 Lister was told, as a student and graduate, that 
 putrefaction in wounds was due to the agency of 
 the oxygen in the air. By the sole right of his 
 genius he gravely questioned it and judged it 
 by the measures of his own insight and power. 
 
 There were many points which served to excite 
 Lister's ^thouglit as to the origin of septic diseases. 
 John Bell pointed out how in some military 
 hospitals, where few operations were performed, 
 deaths were rare and these blood-poisoning 
 diseases absent ; in others, where operations 
 were more frequent and the patients weak owing 
 to prolonged exertions and unhealthy climates, 
 these diseases raged. Lister's previous London 
 chief, John Erichsen, illuminated the extra- 
 ordinary character of pyaemia and serious blood- 
 poisoning by stating that for twenty-five years 
 his private practice had been exempt, but 
 
 86 
 
Perplexity and Enlightenment 
 
 amongst his hospital patients, who stayed for 
 any time in hospital, the tale was very different, 
 and a great number suffered. 
 
 But Lister could not find the clue to these 
 striking differences. He set himself, however, 
 to combat them in his wards by methods of 
 indirect attack. His first method was the in- 
 auguration of a most rigorous cleanliness. In 
 his work upon inflammation he had seen how 
 the most varied substances had diminished or 
 destroyed the local vitality of the tissues. He 
 determined, therefore, to keep wounds, whether 
 accidental or operative, as free from any dirt, 
 foreign matter, or rough handling as possible. 
 
 It may seem strange that cleanliness should 
 not have been a definite habit of surgeons, but, 
 as a fact, there was no law of cleanliness 
 in surgery in those days. The extreme cleanli- 
 ness that now distinguishes the doctor is the 
 outcome of Lister's discoveries and proof of the 
 value of cleanliness. But before Lister the doctor 
 paid no more heed to cleanliness than any other 
 man. Indeed, he often paid less, for what would 
 not be offensive to him owing to familiarity was 
 offensive to other men. Before an operation the 
 surgeon would turn up the sleeves of his coat 
 to save the coat, and would often not trouble 
 to wash his hands, knowing how stained they 
 soon would be. The area of the operation would 
 sometimes be washed with soap and water, but 
 this was not invariable, for the inevitability of 
 corruption made any elaboration of cleanliness 
 
 87 
 
Lord Lister 
 
 appear farcical. The silk or thread used for 
 stitches and ligatures was hung over the button 
 of the surgeon's coat, and during the operation 
 a convenient place for the knife to rest was 
 between his lips. The instruments were washed 
 after the operation with soap and water and put 
 away, but the instruments used for dressing 
 wounds or lancing abscesses were kept in the 
 vest pocket, and often only wiped upon a towel 
 or a piece of rag as the surgeon or dresser moved 
 from patient to patient. 
 
 A story of Sir Astley Cooper, the greatest 
 surgeon of his day, will illustrate how careless 
 even the most eminent doctors were in the matter 
 of cleanliness. Sir Astley had to cut a wen 
 from George IV's scalp, and suffered the usual 
 apprehension lest erysipelas should set in in a 
 magnified form owing to the exalted position and 
 debased habits of his patient. On a day follow- 
 ing the operation he was summoned to the palace. 
 He hurried off in fear, and, though the King 
 was not ill. Sir Astley noticed that the royal 
 eye viewed him with considerable disfavour. On 
 his return he asked his nephew if there were 
 anything wrong with his appearance. " Why," 
 replied his nephew, " I should have put on a 
 white cravat and a clean shirt, or at least have 
 washed my hands before I waited on his 
 Majesty." Sir Astley's shirt and hands were 
 bespattered with blood. " God bless me ! so 
 I ought," he replied, " but I was not aware of 
 it — and the King, sir, is so very particular." 
 
 88 
 
Perplexity and Enlightenment 
 
 What a Icing's surgeon did not do by habit 
 the rest of the profession were not Hkely to do ; 
 and the professional hand, deahng not only with 
 wounds and abscesses but sometimes with post- 
 mortems, was particularly in need of soap and 
 water. Lister introduced into his wards a 
 scrupulous cleanliness. Dressers, nurses, and 
 house-surgeons were made to wash their hands 
 frequently when assisting at operations or 
 dressing wounds. Abundant clean towels had 
 to be provided. Frequent fresh, clean dressings 
 were applied to suppurating wounds. Condy's 
 fluid and other deodorant fluids were lavishly 
 applied. The members of the lay comttiittee 
 expostulated at this extravagance in the cause of 
 cleanliness. 
 
 But all Lister's efforts were without a marked 
 effect upon the occurrence of blood-poisoning. 
 It continued to rage, and Lister continued to look 
 with horror upon its ravages and to ponder about 
 a possible cause. 
 
 In his lectures to his students he insisted that 
 wounds did not naturally pour out pus ; it was 
 not inevitable. They did not do so when they 
 were not irritated. But something caused the 
 juices of the wound to decompose, and the acrid 
 products of decomposition irritated the tissues 
 and caused them to pour out pus. This " some- 
 thing " was something conveyed to the wounds. 
 It was not the air, it was not the oxygen of the 
 air, but it was probably something conveyed by 
 the air, that something in the air of a surgical 
 
 89 
 
Lord Lister 
 
 ward which betrayed its presence by the foetid 
 smell. 
 
 Lister did not discover what this something 
 was himself. But he was always upon the look- 
 out for aid. He ranged through the English, 
 French, and German literature, and his eye 
 swiftly detected the key to his problem in the 
 work of Louis Pasteur. 
 
 After Leeuwenhock's discovery of microbes in 
 1683 there was a lull for a century and a half 
 in further discovery of the nature and import- 
 ance of these minute beings. They were so 
 excessively small that no man could handle them. 
 There were a few speculations as to their nature, 
 and even as to their possible relation to disease, 
 but no work of any moment was undertaken or 
 proofs advanced. 
 
 It was in a province of science outside that 
 of medicine that the philosophic and fundamental 
 importance of minute life was first proved. In 
 1836 Caignard Latour published experiments by 
 which he claimed to prove that the minute specks 
 which can be seen in yeast were alive. They 
 budded and multiplied, and it was by their growth 
 that the fermentation of beer was brought about. 
 Theodor Schwann, the illustrious discoverer that 
 man and animals are composed of hosts of minute 
 cells, also came to the conclusion that yeast was 
 alive, and that as a result of its growth sugar 
 was changed into alcohol in the process known 
 as fermentation. Both the Frenchman and the 
 German, working independently, also took a wide 
 
 90 
 
Perplexity and Enlightenment 
 
 outlook upon the activities of micro-organisms 
 in nature, and held that not only fermentation 
 but also the putrefaction of vegetable and animal 
 substances were due to them, that putrefaction 
 was in fact a form of fermentation. The French 
 botanist Turpin came forward and supported 
 this view of putrefaction. 
 
 A view so powerfully advocated might have 
 made progress had it not aroused to opposition 
 the great Liebig, who resisted the new doctrine 
 in a most strenuous manner. Fermentation was 
 due to chemical substances, which he named 
 ferments, he maintained. It had nothing what- 
 ever to do with living germs or micro-organisms. 
 "As to the opinion which explains the putrefac- 
 tion of animal substances by the presence of 
 microscopic animalculae, it may be compared to 
 that of a child, who would explain the rapidity 
 of the Rhine current by attributing it to the 
 violent movement of the many millwheels at 
 Mainz," he wrote. Helmholtz, who though but 
 a youth was already known to science, undertook 
 a series of experiments, as the result of which, 
 though first supporting Schwann, he finally sided 
 with Liebig. The matter was, then, considered 
 settled, and it did not arise again for over a 
 decade of years. 
 
 In 1854 Louis Pasteur, then thirty -two years 
 old, was made Dean of the Faculty des Sciences 
 at Lille. In 1856 M. Bigo, a local manufac- 
 turer at Lille, met with disappointment in the 
 manufacture of beetroot alcohol. His son was 
 
 91 
 
Lord Lister 
 
 one of Pasteur's pupils, and on his recommenda- 
 tion the elder Bigo came to Pasteur for advice. 
 The result was that Pasteur, who had already 
 pondered the subject, began the series of investi- 
 gations into the mysteries of fermentation and 
 putrefaction which, though he was not a medical 
 man, have had such a profound influence upon 
 surgery and medicine. 
 
 In fermentation he proved finally that living 
 organisms were the primary agents of fermenta- 
 tion. He repeated the observations of Latour, 
 and watched the yeast-cells grow and multiply 
 while the sugar turned to alcohol. He found 
 organisms of another kind invariably present 
 when milk was going sour in the common way 
 with the production of lactic acid, the lactic- 
 acid fermentation. He isolated some little grey 
 masses of these organisms and, scattering them in 
 fresh, boiled milk, saw the characteristic souring 
 follow. He studied, with similar results, the 
 form of fermentation known as butyric, which 
 gives off the smell of rancid butter ; and he 
 found that by means of organisms he could 
 produce lactic or butyric fermentations at will. 
 Each organism, therefore, was specific in its 
 result. It could produce one, and one form 
 only, of fermentation. 
 
 Pasteur was not content with these final proofs 
 of the dependence of fermentation upon minute 
 life, variously known as micro-organisms, 
 microbes, and germs. He determined once and 
 for all to settle the outstanding question of the 
 
 92 
 
Perplexity and Enlightenment 
 
 spontaneous generation of life which the dis- 
 coveries of the microscope had resurrected. 
 
 Scientists no longer believed that dead meat 
 gave birth to flies or mutton gravy to so-called 
 eels. The scornful laughter of Voltaire, who 
 mocked at " men who denied a Creator and 
 attributed to themselves the power of creating 
 eels," had made them ashamed. But with the 
 discovery of microbes the theory, abandoned in 
 the case of eels and mutton gravy, was revived 
 in the case of microscopic life. 
 
 M. Pouchet, a well-known scientist, with the 
 help of his disciples, professed to prove that 
 living organisms could come into being out of 
 dead matter. There was no need of parent or 
 parents. They sprang into life by the process 
 of " spontaneous generation." A conjunction of 
 the necessary elements from the surrounding 
 organic matter and the new life was born. The 
 creation of life was consequently a matter of 
 daily occurrence. 
 
 Experimentation, said Pasteur, is not an easy 
 art ; it requires a combination of considerable 
 natural gifts with long experience. Pasteur 
 believed that Pouchet's results were due to 
 faulty experimentation, and set out to refute 
 them. 
 
 He prepared some flasks with putrescible 
 liquid, which he boiled, and sealed the mouths 
 of the flasks whilst the liquid was boiling. He 
 set the flasks aside for observation. The organic 
 putrescible matter was there ; a conjunction of 
 
 93 
 
Lord. Lister. 
 
 the necessary elements of life could presumably 
 take place and evidence itself in putrefaction of 
 the fluid. It did not take place. There was 
 not the slightest change, and on the flasks being 
 broken open and the fluid microscopically 
 examined no signs of germs or other life 
 could be detected. Why not? Because, said 
 Pasteur, the germs in the air were prevented from 
 getting to it. He plugged a tube with cotton- 
 wool and drew air through it. The cotton -wool 
 became black with the dust which it filtered from 
 the air. He added a fibre of the blackened 
 wool to a flask. The liquid in it soon showed 
 signs of putrefaction. Pasteur wrote to Pouchet. 
 Pouchet replied. Parents or no parents, such 
 was the question over which the famous duel 
 began. 
 
 Pouchet declared that the cotton -wool fibre 
 itself was organic matter, and might, therefore, 
 have provided the particular elements needed for 
 the peculiar conjunction of organic elements 
 which results in the creation of new life. Pasteur 
 heated the necks of his flasks, and when the 
 glass was soft pulled out the necks and bent 
 them downwards. Air, in order to reach the 
 boiled fluid as the flasks cooled, had now to 
 creep up the bent and drawn-out necks. The 
 dust contained in it was deposited in the neck ; 
 none reached the flask. The fluid in the flasks 
 remained sweet indefinitely. 
 
 But, Pouchet replied, how could the air be 
 so thick with germs that wheresoever putrescible 
 
 94 
 
Perplexity and Enlightenment 
 
 stuff was exposed putrefaction always occurred? 
 The clear air must be a veritable mist of 
 microbes. It was a good answer and spurred 
 Pasteur to the most strenuous activity. He 
 skurried hither and thither, testing the air with 
 his flasks in the following manner : He half- 
 filled the flasks with putrescible fluid, drew out 
 their necks to a point, and boiled the fluid in 
 them. Whilst the fluid was in the act of boiling, 
 with a flame and blowpipe he melted the glass 
 of the drawn-out points of the necks and it glued 
 together whilst soft. The flasks were hermetic- 
 ally sealed, in the technical phrase ; no air could 
 enter them. Pasteur then placed several sealed 
 flasks in the air to be tested and waited till abso- 
 lute stillness prevailed so that all dust produced 
 by his own movement had time to settle. With 
 a file he traced a line upon the drawn-out point 
 of the neck below the seal. He then directed 
 a flame momentarily upon the neck to burn away 
 any dust that had settled upon it. He waited 
 once more in order that any dust aroused might 
 again settle. With steel nippers, also passed 
 through the flame, he nipped through the point 
 of the neck of the flasks, which he held with 
 arms outstretched above his head. Air rushed 
 into the flasks, sucked in by the partial vacuum 
 that resulted from their having been sealed whilst 
 boiling. With his flame Pasteur again sealed 
 the flasks, Pasteur now had his flasks filled with 
 the air he desired to test — air which held, of 
 course, its own dust, but was not contaminated 
 
 95 
 
Lord Lister 
 
 by adventitious dust in so far as exceeding care 
 could exclude it. 
 
 Pasteur opened twenty flasks on a country road 
 near Arbois. Eight of them showed putre- 
 factive changes. He took twenty to the top of 
 Mont Pbupet, near Salins, a mountain about 
 2,500 feet in height. Eive flasks showed putre- 
 faction. Pasteur wanted to go up in a balloon, 
 but instead took himself to the Alps. He 
 opened twenty flasks upon the Mer de Glace. 
 Only one showed putrefaction. He opened 
 twenty flasks in a crowded room. All showed 
 putrefaction. The proof that germs were sus- 
 pended in the air in proportions corresponding 
 to the amount of dust in it was complete. The 
 proof, however, was not generally accepted. 
 
 Pouchet, on his side, then undertook similar 
 experiments, and his results differed entirely from 
 those of Pasteur. Everywhere pmtrefaction re- 
 sulted in his flasks. Pasteur did not endeavour 
 to refute him. He felt sure these contrary results 
 were due to faulty experimentation. Pouchet 
 could not, or did not, take the same minute care 
 as he himself had done. Dust from the experi- 
 menter's clothes, fingers, from the pincers had 
 entered the flasks. 
 
 Pasteur had been elected a member of the 
 Acad^mie des Sciences in 1862. The dispute 
 was consequently laid before the Academy in 
 the following year. Further experiments were 
 conducted by other experimenters with Pasteur's 
 technique. Pasteur's results were confirmed. 
 
 96 
 
Perplexity and Enlightenment 
 
 The Academic accepted his demonstration that 
 putrefaction was due to micro-organisms. 
 
 The controversy and the achievements of 
 Pasteur made a great stir in the intellectual world 
 of Paris. Society itself, always anxious to secure 
 anything that presages power, felt called upon 
 to attend the lectures that Pasteur gave upon 
 his work. Three lectures were given in the 
 spring of 1864. The lecture-hall was crowded 
 with scientists and social celebrities, the eager 
 and the elite. The stir created was like to that 
 occurring in England at the same time due to 
 Darwin's " Origin of Species." 
 
 It was not likely that Lister, in his keen search 
 for any clue to the solution of the problems that 
 haunted him, would not hear of the work of 
 Pasteur. He did not, however, discover it until 
 the early part of 1865. He was reading the 
 Comptes Rettdus Hebdomadaires, the weekly 
 publication of the Acad^mie des Sciences. The 
 volumes for i860, 1861, and 1863 contained 
 accoimts of the work upon fermentation and 
 putrefaction. The most important of these 
 papers appeared in the issue for June 29, 1863. 
 It was entitled " Recherches sur la Putrefaction." 
 
 In this paper Pasteur began by saying that 
 the interest and utility of researches into the 
 subject of putrefaction had never been doubted. 
 For a long time men had hoped to gain thereby 
 a knowledge of diseases, and especially of those 
 grouped together as putrid. Unhappily, the 
 natural disgust towards such work, coupled with 
 
 97 G 
 
Lord Lister 
 
 its difBculties, had led to very few profitable 
 results. 
 
 ■His own researches on fermentation, however, 
 led him to endure the repulsive odours and the 
 nausea, and even danger, associated with the sub- 
 ject in the hope of wringing from it secrets of 
 profound and far-reaching value to mankind. 
 " The public utility and the interest of humanity," 
 he quoted from Lavoisier, " ennoble work that 
 is in itself of a most loathsome character and 
 causes enlightened men to see the zeal with which 
 the disgust and difficulties must be overcome," 
 
 The subject of putrefaction, continued Pasteur, 
 was so vast that he hoped to add greatly to the 
 observations he had made. " The most wide- 
 spreading result of my researches is simple 
 enough. It is that putrefaction is determined 
 by living ferments." 
 
 Pasteur went on to say that not only was the 
 oxygen of the air not a necessary component of 
 all putrefactions, but certain microbes causing 
 putrefaction could actually live like fish without 
 free oxygen, and died when exposed to it. These 
 microbes caused putrefaction in the deep layers 
 of putrescible fluid and took their oxygen again, 
 like fish, from the fluid itself, turning it into 
 carbonic acid gas. Other microbes preferred to 
 live upon the surface, and took their oxygen 
 directly from the air. Thus putrefaction could 
 be superficial or it could be deep. It occurred 
 where there was free air and where there was 
 no free air, provided only the microbes had access 
 
 98 
 
Perplexity and Enlightenment 
 
 to the putrescible stufif. In all dead, putrescible 
 matter one condition, and one condition only, 
 was necessary to its putrefaction — namely the 
 presence of microbes. 
 
 Lister, in reading, thought of the paralysis 
 of the tissues, which he had seen come upon 
 them as the shadow of death when they were 
 irritated and injured. During such a temporary 
 death, he thought, the tissues might well be 
 subject to the microbes as if they were actually 
 dead. Their protective vitality was wanting, 
 there was nothing to prevent active microbes that 
 had access to them causing them to putrify as 
 if they were dead. He also thought upon the 
 clotted blood in the wound. He had shown that 
 the reason of blood-clotting was to be found in 
 the loss of vitality of the adja:cent tissues. The 
 clotting, in fact, he had also seen to be a result 
 of the tissues' temporary death, and the clotted 
 blood itself he regarded as dead matter. Con- 
 sequently tissues, when injured, being themselves 
 and their fluids in a state of temporary death, 
 had nothing to save them from putrefaction 
 except an unbroken skin, which guarded them, 
 or a vitality which, though diminished, was still 
 able to resist germs that were neither too multi- 
 tudinous nor too virulent. But if the skin was 
 broken, if the germs were many and active, and 
 if the vitality was depressed to a condition little 
 different from death, then putrefaction was in- 
 evitable. Pasteur's work and his own seemed 
 to link together as if with inevitable conjunction. 
 
 99 
 
Lord Lister 
 
 Lister, as far as is known, did not leave any 
 account of the emotions which the perusal of 
 Pasteur's papers aroused in him. They must 
 have been very profound. One thinks he must 
 have quietly left his house for one of those 
 solitary walks which he was wont to take when 
 a problem or far-reaching thought absorbed him, 
 with the rapid beating of the heart and the feeling 
 of breathlessness that accompany the adjustment 
 of the mind to a sovereign idea. 
 
 IOC 
 
CHAPTER V 
 
 THE DAWN OF SUCCESS 
 
 "In the fields of observation," said Pasteur, in 
 his inaugural address as Dean of the Scientific 
 Faculty at Lille, " chance only favours the mind 
 that is prepared." 
 
 The work of Pasteur gave Lister the know- 
 ledge for which he had been seeking, and gave 
 it to him and to him alone. 
 
 There were hundreds of other surgeons and 
 doctors who would have exulted if by their efforts 
 they could have seen the way to overcome the 
 curse of blood-poisoning. A great number of 
 them must have read Pasteur's writings, still 
 more of them have known of his work. The 
 " chance " was widely scattered, for Pasteur was 
 not working in the dark, nor was he occupied 
 with a subject that had no general interest. It 
 was not obscure and technical, but one as 
 universal in its attraction as the problems with 
 which Darwin dealt. The problem of the origin 
 of life is at least as attractive to the intellectual 
 man and woman as the origin of species, and 
 up till the time of Pasteur it had not been dis- 
 proved that the creation of new life was not 
 
 ID I 
 
Lord Lister 
 
 going on in our midst and upon a very vast 
 scale, and that the death of living matter did 
 not shortly give rise to the birth of new life. 
 Pasteur definitely showed that the evidences of 
 the supposed creation of life were falsely read. 
 He did not show how or when life originated— 
 that remains a mystery. But he did show that 
 the life arising in the processes of putrefaction 
 and fermentation was not de novo, but from 
 parents. In the question of parent or no parent, 
 he convincingly proved the parent. 
 
 The whole question, therefore, was one which 
 aroused intense interest. It affected, or appeared 
 to affect, fundamental beliefs. Pasteur, a firm 
 and devout Catholic, was attacked by representa- 
 tives of the Church. Journalists hurled articles 
 at all and every one, faithfully banging upon the 
 big drum to draw attention to one of the latest 
 shows in the fair of life. The discovery had 
 ample advertisement, both for the serious -minded 
 and the frivolous. 
 
 Yet the only mind amongst all the physicians 
 and surgeons to receive enlightenment was 
 Lister's. It is necessary to emphasize this point, 
 for Lister's name is, of course, wrapped up with 
 that of antisepsis. Others, as we shall see, had 
 made use of antiseptics such as carbolic acid 
 and chloride of lime. The ancient Egyptians 
 had made use of antiseptics to preserve dead 
 organic matter (the word in relation to the dead 
 is scarcely suitable), and Sir John Pringle, 
 President of the Royal Society in 1772, to whom 
 
 102 
 
The Dawn of Success 
 
 Pasteur paid tribute as " le celebre medecin 
 anglais Pringle" had done the same. But what 
 singled Lister out from all his contemporaries 
 was that he, with his peculiar intimacy with the 
 nature of vitality, saw Pasteur's work in the light 
 of a first principle ; he saw it through an under- 
 standing of human vitality, and in this, to my 
 mind, he showed himself not only unique amongst 
 his professional brethren, but a profounder 
 philosopher than Pasteur himself. But I do not 
 desire to urge this p>oint. There was no shadow 
 of rivalry between the two great men during 
 their lifetime ; there should be none after their 
 deaths. 
 
 Lister saw a vision of countless minute enemies 
 awaiting the paralysis of the living tissues unpro- 
 tected by the skin, just as vultures await the 
 paralysis of a dying beast before they begin their 
 fell work. Lister was almost certainly the only 
 man in the world to whom that vision was pecu- 
 liarly vivid. He saw the very refinements and 
 details of the drama that would occur between 
 the tissues and their enemies. Vitality, a word 
 to others, was as familiar to him almost as the 
 expressions and intonations of a child to its 
 mother. It was intimate, personal, and pecu- 
 liar to him ; it was his own . He had seen it with 
 his own eyes, thought it with his own thoughts, 
 described it with his own words. He had not 
 accepted it from others ; it was his own, freshly 
 and originally. His conception of it, therefore, 
 had all the power of egotism, all that peculiar 
 
 103 
 
Lord Lister 
 
 virility and strength that is implied in the phrase 
 " my own " ; and " his own," belonging to the 
 first principles of life, the gifts he fashioned from 
 it, have had the widespread effects which gifts 
 springing from first principles have. 
 
 Consequently, Lister, having read Pasteur's 
 papers, was ready to begin practical work at 
 once. His objects were, first, to destroy any 
 microbes that, owing either to an accident or 
 an operation, had reached the tissues of a patient ; 
 and secondly, to prevent any fresh ones getting to 
 the wound. The tissues, unattacked, would have 
 time to, recover their vitality, and by growth 
 and scar close the wound. 
 
 Lister therefore sought for some chemical 
 which would kill the microbes which, if living, 
 set up putrefaction in a wound. His choice fell 
 upon the antiseptic which still holds the premier 
 place— namely, carbolic acid. 
 
 An obvious and objectionable part of the pro- 
 cess of decay is the odour produced. The 
 Carlisle authorities made use of carbolic acid to 
 abolish the odour of sewage, and it proved 
 successful. Lister heard of its success and went 
 to Carlisle to see the process for himself. Lister 
 concluded that it prevented the odour by killing 
 the causes of putrefaction— namely, the microbes. 
 Other surgeons also knew of this power of 
 carbolic acid to decrease foetor, and they had 
 used it in offensive wounds for that purpose. 
 But they had not understood the mode of its 
 action ; they used it unintelligently, and conse- 
 
 104 
 
The Dawn of Success 
 
 quently with very varying and sometimes harmful 
 results. Lister used it intelligently. He used it 
 before the foetor arose ; he used it deliberately 
 to kill the causes of the condition that gave rise 
 to the foetor. 
 
 The carbolic acid of that day was not the 
 limpid, oily fluid that it is to-day. It was then 
 a disagreeable -looking fluid, dark with tarry im- 
 purities and quite insoluble in water. Lister, 
 therefore, was forced to use it in its full strength, 
 and it seems strange now that it did not cause 
 symptoms of poisoning to arise in the patient 
 in addition to poisoning the microbes. But it did 
 not do so. What it did was to excite the 
 wounded surfaces to bleeding. The blood 
 mingled with the carbolic and formed a hard 
 crust. This was the first form Lister's famous 
 antiseptic scab took. 
 
 Lister's first attempts in the new treatment 
 were in patients suffering from injuries which had 
 not only broken a bone but had also torn the 
 skin— cases technically known as compound 
 fractures. Through the torn skin air and dirt 
 could pass to the damaged and paralysed tissues . 
 
 The choice of these cases was an obvious one. 
 The impressive difference between the healing 
 of fractures of bones in which the skin remained 
 intact, and those in which the skin was torn had 
 struck every surgeon. The first got well with- 
 out much ado ; the second always resulted in 
 profuse suppuration, and not infrequently ended 
 in death. Their terrible nature has already been 
 
 105 
 
Lord Lister 
 
 shown by quotations from John Bell. They, were, 
 without doubt, the most serious injuries from 
 which men, and especially the inhabitants of 
 such a city as Glasgow, could suffer. 
 
 Lister determined to concentrate at first upon 
 these cases— their very fatality justified him. One 
 can dare an experiment upon an otherwise hope- 
 less, or almost hopeless, type of case which one 
 ought not to dare in less dangerous forms of 
 sickness. 
 
 Lister's first attempt was made upon a man 
 who had sustained a compound fracture of the 
 leg. It was made in March, 1865. A great 
 deal, obviously, depended upon the result, and 
 the result was death. The treatment received 
 a check at its initiation. The case had been 
 unfavourable from the beginning. The injury 
 was severe and the man unhealthy. Lister 
 deferred the repetition of his experiment until 
 a patient arrived whose initial vitality and health 
 was able to make a better fight than that of this 
 worn-out product of a factory city. 
 
 A little boy, eleven years of age, had been 
 run over by an empty cart. The wheel passed 
 over his leg, broke both bones, and caused a 
 wound through the skin that was an inch and 
 a half long. There was not very much bruising 
 or extravasation of blood into the muscles of 
 the leg. The injury, in fact, though certain to 
 result in suppuration, with the risk of greater 
 dangers, at the commencement was not very 
 severe. Lister directed his house-surgeon to take 
 
 106 
 
The Dawn of Success 
 
 a piece of lint of such size that it would cover 
 and overlap the wound on all sides, to dip it into 
 the crude carbolic acid, and to lay it upon the 
 wound. The bones were then set and the leg 
 put into splints. For three days all went well. 
 Upon the fourth day the boy complained of pain 
 in the wound. Suppuration generally began in 
 wounds upon the fourth day. Doubtless the pain 
 meant tliat suppuration had begun, and Lister was 
 faced with a second failure. With anxiety he 
 removed the splints and the lint and examined 
 the wound. It was encrusted with a scab. There 
 was no odour except that of the carbolic ; there 
 was no sign of suppuration. Another reason 
 for the pain was revealed. The crude carbolic 
 had burnt the skin, had caused the horny layers 
 to peel off, and had left a raw and tender surface . 
 
 Greatly relieved and encouraged. Lister 
 re-dressed the wound with a piece of lint 
 which had been soaking in a vessel of water, 
 at the bottom of which lay a thick, undissolved 
 layer of the oily-looking carbolic acid. The 
 sore was soothed, and gradually the pain passed 
 away. When the wound was next examined 
 the scab was still intact and the wound beneath 
 it apparently healthy. The raw surface of the 
 skin alone oozed with a little pus. Such was 
 the cleanly picture which presented itself, instead 
 of the loathsome discharge which soaked through 
 layer after layer of lint and assailed the nostrils 
 with its offensive odour. 
 
 Lister's comment upon this apparently unique 
 
 107 
 
Lord Lister 
 
 success was calm and restrained. There was 
 no attempt to trumpet it forth or exaggerate 
 its significance. Like Darwin, Lister was dis- 
 tinguished by a singular serenity, and also, like 
 his famous contemporary, he was far more in- 
 clined to be the critic than the lauder of himself. 
 " This, no doubt, was a favourable case," he 
 wrote in his paper upon these cases in 1867, 
 " and might have done well under ordinary 
 treatment. But the remarkable absence of 
 suppuration, and the immediate conversion of 
 the compound fracture into a simple fracture " 
 (by the hard scab protecting the purified wound, 
 as does the vmbroken skin) " with a superficial 
 sore, were most encouraging facts," 
 
 Whether the easy recovery of this little boy 
 was due to Lister's treatment or not, the next 
 case upon which he experimented showed how 
 needful it was for him to be present and to 
 direct all the operations with his own sight and 
 mind, which alone were intelligent in the matter. 
 
 A healthy man, thirty-two years of age, had 
 been kicked upon the leg by a horse. The bones 
 were broken, and the skin was also broken by 
 a wound an inch in length, from which the blood 
 welled. A piece of lint was dipped into carbolic 
 and laid upon the wound. Carbolic dripped 
 from this into the wound and mingled with the 
 blood. A hard crust or antiseptic scab was 
 formed. Carbolic acid is volatile. Consequently 
 the scab, at first antiseptic owing to the presence 
 of the carbolic, would lose this quality in a round 
 
 108 
 
The Dawn of Success 
 
 of hours owing to the evaporation of the carbolic. 
 To prevent this Lister laid some oiled paper over 
 the lint. The wound was now covered with an 
 antiseptic cap that was airtight except at its 
 edges. The leg was then splinted. 
 
 All went well until the seventh day. The 
 patient's pulse was slow, his appetite was good, 
 there were no signs of fever. The wound on 
 being examined showed itself to be quite free 
 from suppuration. But on the seventh day the 
 injured man complained of pain in the wound. 
 Lister examined it, and once again his examina- 
 tion, which might have revealed failure, assured 
 him. The wound was healthy, but there was 
 considerable irritation of the skin owing to the 
 crude acid. Milder applications were used, as 
 in the case of the boy, and soon the man was 
 well except for a small superficial sore. 
 
 This small sore, one would think, was of no 
 
 moment, but at the time Lister happened to be 
 
 called away from Glasgow for a few weeks. 
 
 The sore, safe under his charge, became as of 
 
 old a portal of death. Gangrene seized upon it 
 
 and gnawed its way rapidly into the living tissues . 
 
 Only after amputation of the limb and a serious 
 
 illness accompanied by great agony was the man, 
 
 a mere cripple of his former self, discharged from 
 
 the hospital. Lister was gravely disappointed to 
 
 find the old enemy return when he was not 
 
 present. But the event confirmed him in the 
 
 conviction that the treatment must be conducted 
 
 and proved by himself alone. 
 
 109 
 
Lord Lister 
 
 The next two cases that Lister treated were 
 compound fractures of the arm. In neither case 
 was there severe bruising or laceration, and the 
 cases were such as might have recovered under 
 the usual dressings, namely either a piece of dry 
 lint or one dipped into ordinary water. Lister 
 treated them with the lint soaked in carbolic, 
 covered by a cap of sheet-lead to prevent the 
 evaporation of the carbolic . They healed without 
 suppuration . 
 
 In May, 1866, a case came under Lister's 
 charge well calculated to test the value of the 
 new treatment. 
 
 A man of the age of twenty-one was super- 
 intending the action of a crane in an iron- 
 foundry. Whilst he was doing so a chain slipped 
 and a heavy case fell obliquely upon his leg. 
 A terrible injury resulted. Both the bones 
 were broken and the skin was slit up. The 
 torn blood-vessels had bled freely into the 
 muscles and tissues of the leg. A further 
 complication had occurred. Whilst the man was 
 being carried to hospital, a considerable amount 
 of air had been sucked into the wound owing to 
 the movements of the leg, and this air had been 
 churned up with the blood. The imprisoned air 
 and blood together pressed upon the injured 
 tissues. With their vitality already seriously 
 diminished, the tissues were being squeezed to 
 death by the pressure of blood and air. 
 
 In such a case the patient's chance is about 
 as bad as it can be, so paralysed are the tissues 
 
 no 
 
The Dawn of Success 
 
 that they rapidly fall victims to their enemies 
 the microbes . There was no case in which defeat 
 of the man and triumph of the microbe was 
 more certain unless some powerful mercenary 
 were called in to protect the former's paralysed 
 vitality. Lister saw the man within three and a 
 half hours of the accident, so that such infection 
 as had already occurred had not a long start 
 of him. Lister resolved not to amputate, which 
 was the treatment that any surgeon adopted in 
 such cases. He determined to defend the vitality 
 of the tissues until, thoroughly restored and care- 
 fully guarded from further attack, they set about 
 the healing of the broken bones and the restora- 
 tion of the torn and disorganized muscles. 
 
 Lister's first act in the defence of the tissues 
 was to relieve them from compression. With 
 great caution he squeezed as much blood and 
 air from them as he could, distributing his 
 pressure over a wide area, so as not to pinch 
 the damaged tissues. His next objects were to 
 kill any microbes that had got into the wound and 
 to prevent the possibility of fresh ones entering. 
 The usual lint soaked in carbolic was laid upon 
 the wound and the lint was covered by a piece 
 of tin-foil to prevent evaporation. The scab 
 formed and the leg was splinted. Protected and 
 at rest the tissues were left to regain the mys- 
 terious quality of vitality. 
 
 At first there was a little fever and fast pulse, 
 but as the days passed the fever instead of 
 mounting fell . Instead of the great swollen limb, 
 
 III 
 
Lord Lister 
 
 the throbbing pain, and the burning skin, the 
 limb decreased in bulk, the skin was cool, the 
 man had no pain. 
 
 The deep wound healed xmder the scab as 
 quietly as a cut finger. The skin, excoriated by 
 the carbolic, oozed a little . In six weeks the man 
 was well except for the hardening of the scar. 
 
 This case Lister was unable to describe as 
 " a favourable one, which might have done well 
 under ordinary treatment." It was rather one 
 " well calculated to test the value of carbolic 
 acid," and its answer had been emphatically in 
 the affirmative. 
 
 In these cases it will be seen Lister had caused 
 healing to occur under a scab infiltrated with a 
 substance which prevented its putrefaction. 
 
 A cynic might observe that all large wounds 
 in animals heal under a scab, and the cynic would 
 be quite right. He might even justly observe 
 that animals were never exposed to the peculiar 
 risks of these accidents as was man. Lister 
 did in fact but permit a man in hospital to have 
 the same chance as an animal in nature. But 
 for man to get to the level of the animal in this 
 matter was an enormous advance. The general 
 chance for man was such that, had the animals 
 been blessed with the peculiar gifts Mr. Kipling 
 endows them with, and had they in consequence 
 been cognizant of the insensate charity of man, 
 they must have hung their heads in shame that 
 such folly should be a quality of the lords of the 
 world. 
 
 112 
 
The Dawn of Success 
 
 Encouraged by this striking success. Lister in 
 the next severe case that came under his charge 
 used carbolic with more daring. A boy of ten 
 had his arm broken in, three places and the 
 muscles badly torn. One of the broken bones of 
 the unfortunate child was protruding for about 
 an inch through the skin. Lister had the boy 
 put under chloroform, and then cut off the head 
 of the protruding bone and the tags of torn 
 muscle. He then soaked a piece of lint in the 
 carbolic and sponged out the wound with it. 
 Having cleansed the depths of the wound in 
 this way, he dressed it in the usual manner. He 
 then awaited the result. 
 
 The result was curious. Upon the fourth day, 
 the day of suppuration, a pale grey discharge 
 began to flow from the wound. Pale grey was 
 always an ominous colour. It was the colour 
 of hospital gangrene. But this grey was, it 
 seemed, harmless. The boy's pulse did not 
 become faster, but slower ; his cheek was not 
 flushed but cool. Clearly in spite of the dis- 
 charge, the child was recovering from his terrible 
 injury. 
 
 Lister, however, feared this discharge was the 
 beginning of suppuration, so he applied the car- 
 bolic again freely to the scab, from under the 
 edges of which the discharge came. His con- 
 jecture appeared to be right. The grey dis- 
 charge not only increased in quantity, but it 
 thickened and turned to pus. Such a result 
 might easily have baffled an investigator. 
 
 113 H 
 
Lord Lister 
 
 Lister was attempting to avoid suppuration 
 occurring in the wound by a remedy, with the 
 result that the remedy was found to provoke it. 
 Lister fortunately was not perturbed. He saw 
 the boy as a whole and not merely as a broken 
 arm. The boy was free of pain, his face was 
 fattening, he looked confident, he had no lines 
 of suffering nor the peculiar fear in the eyjes 
 which the observant stu-geon knows how to 
 recognize. Lister continued to apply carbolic, 
 and it soon became abundantly clear that it was 
 the carbolic that provoked the suppuration. Its 
 irritation had made the skin sore and ooze in his 
 previous cases. It now caused the tissues them- 
 selves to ooze in a like manner. But this dis- 
 charge was very different to the acrid, offensive 
 discharge that came from a wound infected with 
 microbes. It caused no fever or other symptoms 
 of blood-poisoning, and its cessation was readily 
 brought about by the use of mild or less frequent 
 carbolic. The boy made an uninterrupted re- 
 covery, and Lister learned that he could use 
 carbolic freely in the depths and crevices of the 
 wound and destroy any germs that had found 
 their way to them. 
 
 The fifth severe case in which Lister used the 
 carbolic treatment was notable for the deter- 
 mined grip which hospital gangrene took upon 
 the case and its efforts to defeat the good results 
 of the innovation. A " fine, intelligent boy," 
 seven years of age, was knocked down by an 
 omnibus loaded within and without, and the 
 
 114 
 
The Dawn of Success 
 
 wheels of this heavy vehicle passed" over his 
 right leg and smashed it unmercifully. So ter- 
 rible was the shock and loss of blood' that the 
 contemplated amputation was n^ot undertaken for 
 fear it should extinguish the small spark of life 
 that was left. Lister applied carbolic freely to 
 the torn and crushed tissues. For a few days' 
 the child hovered between life and death and 
 then Lister's triumph began. The huge wound 
 commenced to heal, and the boy, for whom Lister 
 evidently had no little love, got better in health. 
 But there had been one small accessory sore 
 caused by the accident. It was situated at sL 
 little distance from the major wound and not 
 connected with the broken bones or torn muscles. 
 This sore had not been treated with carbolic 
 acid, and it was there that hospital gangrene 
 laid its dread hold. The gangrene had eaten its 
 way a little down into the flesh. Lister deter- 
 mined to find out how extensive it really was. 
 He had the child put under chloroform and lifted 
 the scab. Directly beneath the scab the tissues 
 were healthy, but deeper down " a sight pre- 
 sented itself which filled me with horrior." A 
 battle ensued between antisepsis, caustics, and 
 hospital gangrene. For months it continued, the 
 gangrene, beaten back again and again, stub- 
 bornly retaining its hold and now and then 
 making rapid and unexpected inroads. It was 
 not until Lister was able to secure a separate 
 airy room for the child that the gangrene was 
 finally beaten. The boy recovered, and so well 
 
Lord Lister 
 
 had the poisonous effects of the gangrene been 
 held in check that his health was soon excellent. 
 The limb was partly crippled, but before he 
 left the hospital he was able to limp about the 
 ward. The victory was by no means complete, 
 but the limb, in spite of the months of ding- 
 dong battle, was of such use that the child could 
 get about without a crutch. He had been ill 
 for nine months. Only the utmost skill, care, 
 and perseverance saved him. 
 
 The sixth severe case resulted also in a long 
 fight between the forces of decomposition and the 
 antiseptic power of carbolic. The patient was 
 a man of fifty, broken down by work and ill- 
 living. For four months the carbolic failed ,to 
 get complete control over the putrefaction. The 
 wall of a blood-vessel was attacked, an ulcer 
 formed upon it and ate its way to the vessel. 
 Blood gushed out, but the bleeding was quickly 
 stopj>ed ; in a few days it gushed forth again . 
 Worn out by loss of blood, the man eventually 
 sank and died. 
 
 These six cases, in addition to four successful 
 cases under the care of other surgeons who 
 allowed Lister to direct the treatment, constituted 
 his first antiseptic experience . They were spread 
 over a period of eighteen months. There was 
 also the initial case treated in March, 1865, ain'd 
 the two fractures of the arm with small wounds. 
 In all there were thirteen cases. Of thtese 
 thirteen two died. Two suffered from hospital 
 gangrene, one recovering with and one without 
 
 116 
 
The Dawn of Success 
 
 amputation. The other nine patients recovered 
 as if they had suffered from' simple fractures and 
 the unbroken skin had offered an impervious 
 barrier to the microbes. Two of these, the cases 
 of broken arm, had such slight skin wounds 
 and general injury that Lister did not reckon 
 them as important. It was in the remaining 
 seven cases that he saw the dawn of success. 
 
 Patients with compound fractures of course 
 frequently recovered without amputation. They 
 even recovered in some cases without suppura- 
 tion. When the injury and bruising was slight 
 and the skin wound small, sometimes a natural 
 scab would form, under which the deeper parts 
 of the wound would heal without trouble. This 
 occurred much more frequently in patients not 
 brought to the hospital, but it also happened 
 in hospitals, so that the famous John Hunter 
 recommended that if a scab formed it should 
 be let alone and the chance of deep suppuration 
 occurring beneath it risked. Other cases of 
 compound fracture recovered after weeks and 
 months of severe and exhausting suppuration. 
 
 The figures of Lister's cases, therefore, were 
 not large enough to be convincing. Thirteen 
 cases with varying results were not a sufficient 
 basis upon which to found a new treatment, 
 unless there was something very peculiar about 
 any of the cases. There was, in point of 
 fact, this peculiarity. Seven of the cases 
 were cases in which limbs had not only 
 been broken and exposed, but had also been 
 
 117 
 
Lord Lister 
 
 severely lacerated. Yet these seven cases 
 had healed without suppuration, without the 
 exhausting hectic fever, without the intoler- 
 able pain. These seven cases in the infected 
 wards of the Glasgow Infirinary were wholly 
 without precedent. They were quite abnormal. 
 The abnormal success, which held within itself 
 the possibility and even thte likelihood of 
 becoming the normal, the rare success which, 
 methodically attained, promised to become com- 
 mon were, indeed, most noteworthy. They con- 
 stituted the dawn of a success which grew quickly 
 to the midday of a complete triumph. 
 
 ii8 
 
CHAPTER VI 
 
 THE WAY TO PERFECTION 
 
 In this struggling and confused modern world 
 of ours there is little that is more soothing and 
 encouraging to contemplate than the calm, 
 assured march of one man to perfection. 
 
 Lister had already convinced himself that he 
 had gained the mastery of compound fractures. 
 He now turned his attention upon a large group 
 of cases distinguished by their sad character 
 and by the utter failure of the surgeons who had 
 to deal with them. These cases were the many 
 forms of cold or chronic abscess. It is a disease 
 that was very common then ; it is very common 
 now. There is not a reader, probably, who has 
 not known of cases amongst relatives or friends. 
 Whether in the form of glands in the neck 
 becoming abscesses, or of hip-joint disease or 
 of spinal disease with resulting abscesses, chronic 
 abscess is common enough. The most serious 
 form, owing to its depth in the body, is the 
 chronic abscess resulting from disease of the 
 spine. Disease of the spine sometimes leads 
 to hunchback and gets well. Sometimes it leads 
 to chronic abscess. The matter in such a case 
 
 119 
 
Lord Lister 
 
 passes down in front of the spine and commonly 
 forms a white swfelUng in the groin. This form 
 is known as psoas abscess, because the matter 
 follows the course of a muscle called the psoas 
 muscle. The ill-health of the patient, the tender 
 spine, and the slowly increasing swelling in the 
 groin were the signs of a disease, a shadow of 
 death, from w^hich, before Lister's day, there 
 was no drawing back. The abscess, slowly 
 increasing, would eventually burst and discharge 
 its contents, or else be opened by the surgeon's 
 knife. In either case, whether the patient were 
 wealthy and at home or poor and in hospital, the 
 same doom was inevitable. A condition known 
 as hectic set in, under which the sufferer more 
 or less quickly wasted and melted away. With 
 other forms of chronic abscess it was a similar 
 tale. 
 
 Mr. Erichsen, Lister's chief at University 
 College Hospital, in 1864 wrote the following 
 surgical description of hectic :— 
 
 " Hectic does not occur so long as an abscess, 
 however large, continues unopened, but it super- 
 venes with great rapidity wihen once its contents 
 are discharged. I have known a large abscess 
 to exist unopened for two years without any 
 constitutional disturbance, but so soon as it was 
 opened well-marked hectic set in, which speedily 
 carried off the patient. 
 
 " Hectic is essentially a fever of debility, con- 
 joined with irritation. Emaciation and general 
 loss of pjower invariably accompany it. The 
 
 120 
 
The Way to Perfection 
 
 pulse, which is quick, small, and compressible, 
 rises from ten to twenty, beats above its normal 
 standard ; the tongue becomes red at the ed^es 
 and tip ; the cheeks are often flushed and the 
 eyes glistening, with dilated pupils— all these 
 symptoms have a tendency to exacerbations after 
 meals and towards evening. There is also 
 increased action either of the skin, bowels, or 
 kidneys. Thus^ profuse sweating, copious 
 purging, and abundant red deposits in the urine 
 take place ; these discharges often alternate with 
 one another, melting the patient away, and hence 
 are termed colliquative. The debility, gradually 
 increasing, the patient rapidly wastes, and at 
 last dies from sheer exhaustion, the conjoined 
 result of fever, malnutrition, and wasting dis- 
 charges," 
 
 Hectic is not a condition wholly abolished 
 to-day. The success with which Lister treated 
 it is not general to-day, for it requires a most 
 minute and patient care. Other reasons apart 
 from treatment also cause it to be a condition 
 still seen by doctors . It is one of great sadness . 
 It is more common in young people and children 
 than in the old, and some of the saddest cases of 
 disease which I have witnessed have been cases 
 of chronic abscess, either psoas or connected 
 with some joint, bone, or glands, which sapped 
 away young and expectant life. In the days 
 when Lister began his work upon them these 
 unfortunates were all too common. The wards 
 would always show one or more patients with 
 
 121 
 
Lord Lister 
 
 faces delicate in very truth with the fine silken 
 skin, the red flush upon the cheek-bones, the 
 glittering eye distinguished by the contrast of 
 the brilliant blue -white sclerotics with the large 
 black pupils, the red-glazed lips, and the temples 
 with their pale blue veins. The fragile prettiness 
 of children suffering from hectic, coupled with 
 the virtues of exhaustion, the unresisting patience, 
 and the passive obfedience, moves the hearts of 
 those who are touchted by pathos, and provokes 
 others to an intolerable anger that such a blight 
 should fall upon the blossom of life. 
 
 Such cases of chronic abscess, it is now known, 
 have for a cause the tubercle bacillus. Before 
 these abscesses are opened, as Lister from the 
 first pointed out, they are wholly free from the 
 germs of putrefaction. But if they burst or are 
 opened in a way not absolutely clean, or dressed 
 uncleanly, then the germs enter and putrefac- 
 tion begins at once, for the vitality of the tissues 
 surrounding the abscess is weak and unable to 
 offer any effective resistance. 
 
 Such, too, was the mental picture which Lister, 
 in the light of the new knowledge, formed of 
 the tissues about those abscesses. That which 
 was a mystery to others was clear to him. It 
 is true that the others did not believe it was a 
 mystery to themselves. They thought the putre- 
 faction occurred owing to the entrance of that 
 fiery element of the atmosphere, oxygen, whose 
 ardency set the burning hectic alight. They 
 even devised valvular slits into the abscess, so 
 
 122 
 
The Way to Perfection 
 
 that it could discharge its contents without the 
 air entering. But they, made these shts with 
 impure knives and hands not surgically clean, 
 and did but start the final dfecline of their patient . 
 Better put off the evil day as long as possible 
 was Erichsen's advice and that of most leading 
 surgeons. Let the patient go about with the 
 abscess untreated, for where the surgeon stepped 
 in to aid there the sexton followed all too 
 speedily. 
 
 Lister, after his experience with compound 
 fractures, now saw hope where formerly there 
 had been no hope . 
 
 He did not make trial at once with these 
 serious cases. He began with the common cases 
 of acute abscess, carbimcles, boils, whitlows, 
 and the like. After some initial failures, he 
 gained success. These acute abscesses tend to 
 get well. With Lister's treatment they all got 
 well rapidly and cleanly, and the treatment he 
 then adopted is still the most successful. Basing 
 himself upon these successes, he then decided 
 to make an attempt upon a patient suffering 
 from one of the larger chronic abscesses, an 
 attempt in which failure would surely result in 
 death, but success would open up an unprece- 
 dented path of hope to these unfortunates. 
 
 A middle-aged man with a psoas abscess 
 occupied one of the beds in his wards. The 
 abscess was a large one, extending from the 
 spine to the groin, and holding over a pint of 
 matter. Lister decided to open it. He had by, 
 
 123 
 
Lord Lister 
 
 this time found that the undiluted carbolic acid 
 was too caustic to be kept for any, time in con- 
 tact with the skin. He therefore dissolved the 
 carbolic in four parts of boiled linseed-oil. He 
 took a rag, soaked it in the carbolic oil, and 
 then laid it over the swelling in the groin, leaving 
 the carbolic to cleanse the skin . He also soaked 
 his lancet in the oil. 
 
 He then carefully, raised the edge of the rag, 
 slipped his lancet undemieath it, and thus, under 
 cover of a carbolic veil, opened the abscess. 
 The matter welled up and ran from under the 
 rag. When it had cea,sed to do so a fresh rag, 
 soaked in the carbolic oil, was spread upon the 
 wound and the surrounding skin. Lister then 
 mixed some of the carbolic oil with carbonate 
 of lime to make a putty, which he named " the 
 antiseptic putty." He spread this putty upon thin 
 sheets of metal and moulded this dressing to 
 the wound and surrounding skin, with the putty, 
 next to the wound. In this ingenious way Lister 
 set between the wound and the outer world an 
 antiseptic cap, which preserved both its con- 
 sistency and its antiseptic powers. The carbolic 
 could not evaporate through the metal, and the 
 putty was too firm to be washed away by the 
 discharge, which passed through it and oozed 
 from under the edges of the metal sheeting. 
 At this edge the germs could get to it and cause 
 the usual decomposition. But it was then some 
 distance from the wound and the weakened 
 tissues that surrounded the abscess. Lister thus 
 
 124 
 
The Way to Perfection 
 
 removed the situation of the decomposition from 
 the wound and abscess to a safe distance out- 
 side and away from them. 
 
 Lister's attention and care in this case was 
 extraordinary. From day to day the most trifling 
 detail or sUght alteration of the conditions was 
 carefully considered and met. In general, day 
 after day passed with tedious monotony, without 
 any signs of retrogression and without any 
 relaxation of his rightly meticulous zeal. Finally, 
 after six months the reward came. " I had the 
 inexpressible happiness of finding the sinus 
 closed," he wrote.. " For months past we had 
 persevered with the antiseptic dressing, although 
 the discharge did not amount to more than a 
 drop or two of serum in the twenty-four hours, 
 well knowing by bitter experience that so long 
 as a sinus existed the occurrence of decomposi- 
 tion might produce the most disastrous conse- 
 quences,, and at length our patience has been 
 crowned with success." 
 
 The reader will see wihat peculiar gifts of 
 perseverance and profound faith in the new germ 
 theory, of decomposition were necessary to effect 
 this success. The change in the way of regard- 
 ing a case was a radical one. Under the 
 knowledge and feeling of the inevitability of 
 decomposition in these and kindred cases, 
 surgeons were wholly unaccustomed to minute 
 care. There was no association and tradition 
 of minute care connected with such hopeless 
 conditions. The radical change and complete 
 
 125 
 
Lord Lister 
 
 break from the accustomed attitude Lister alone 
 was able to make. His professional brethren 
 attempted his treatment, but without his 
 indomitable patience and faith. Either they 
 relaxed their attention when success seemed 
 assured or else abandoned it upon the first drop 
 of pus and adopted the fatal poultice, or their 
 curiosity tempted them to expose the wound too 
 freely to see how matters stood, and even to 
 probe the wound and measure its depth and 
 size. Before Lister had been at work three years 
 we find him asserting that " without a, firm faith, 
 in the truth of the germ theory, perplexity and 
 blunders must be of frequent occurrence " ; that 
 the abandonment of his treatment for water- 
 dressings or poultices when a little pus appeared 
 " would in many cases sacrifice a limb or a 
 life " ; and warning other surgeons not to " pry 
 into the source of suppuration so long as all is 
 going well otherwise ; for such a course, by 
 admitting germs into the interior, may produce 
 the most disastrous consequences in an otherwise 
 promising case." Already he wa,s beginning to 
 be hampered by practical men, who wanted to 
 get to work without due consideration and 
 humble studentship— incidental men, one might 
 call them, in that they live in the day's work, 
 want quick returns, and like tO: be "in the 
 know " of w'hat is going on in the world of men, 
 rather than humbly wait up>on the guidance of 
 Nature. The firm faith which restrained Lister 
 from satisfying what, in his case, amounted to 
 
 126 
 
The Way to Perfection 
 
 the almost legitimate curiosity and inquiry of 
 the pioneer, because he considered that if the 
 germ theory were true his patient would suffer 
 from his prying, is not one of the least of those 
 magnificent qualities of character which led him 
 to success. 
 
 Lister repeated his treatment of chronic 
 abscess in such patients as were fortunate enough 
 to be put in his charge. " I have opened 
 numerous abscesses connected with carries of the 
 vertebrae, the hip, knee, ankle, and elbow, and 
 in all caises I have found the discharge become 
 in a few days trifling in amount, and in many 
 it has ceased to be puriform in twenty-four 
 hours." How different to the " colliquative dis- 
 charges," under which the patient melted away, 
 in the graphic language of Mr. Erichsen ! 
 
 Darwin worked for twenty-one years at the 
 completion and proof of his theory before he 
 gave it to the world. But the antiseptic theory 
 of his compeer was too fraught with practical 
 good to mankind for Lister to keep it to himself 
 until completed to his liking. Hence, though he 
 resembled Darwin perhaps more closely than any 
 man in the century in his complete absorption in 
 his work and indifference to any fame it might 
 bring him, before he had fully proved this treat- 
 ment of chronic abscess he published it in the 
 Lancet. Its results had been satisfactory and 
 consequently " it does not seem right to with- 
 hold it longer from the profession generally." 
 "In suppuration of the vertebrae or of the 
 
 127 
 
Lord Lister 
 
 joints," he continued, " the results of this system 
 are such as I ventured with trembling hope to 
 anticipate ; patient perseverance being rewarded 
 by a spontaneous cure in cases where excision, 
 amputation, or death must have resulted from 
 any other known system of treatment. In short, 
 the element of incurability has been eliminated 
 from caries." 
 
 Quiet and restrained as always, his report 
 was absolutely free from all tinge of adver- 
 tisement or self -laudation. There could scarcely 
 be a more simple announcement of a great 
 victory over a disease, hitherto regarded as 
 hopeless, than the words, " in short, the element 
 of incurability has been eliminated." " The 
 trembling hope " of one whose heart had been 
 sorely tried by the picture of incurable suffering 
 had been rewarded. Compound fractures and 
 chronic abscesses having fallen before him and 
 such lesser troubles as cuts and ulcers having 
 yielded to him, Lister now turned to the great 
 problem of making operations safe. He recog- 
 nized that pure carbolic was unsuitable in opera- 
 tive technique. The cut made by a surgeon's 
 knife was clean and did not lacerate the tissues. 
 The injury to their vitality was not great. At the 
 same time, blood and serum collected in the area 
 of operation and were wont to putrefy readily. 
 The problem, therefore, was not so simple as the 
 placing of an antiseptic veil and cap over a 
 wound. That was sufficient after the operation, 
 but what was to be done to shield the tissues and 
 
 I2g 
 
The Way to Perfection 
 
 juices during the operation ? Lister tried various 
 plans. " I have devoted a good deal of atten- 
 tion to this class," he said to the members of 
 the British Medical Association meeting in 
 Dublin in August, 1867, "but I have not as 
 yet pleased myself altogether with any of the 
 methods I have employed." He had obtained 
 from Mr. Calvert, of Manchester, a purer form 
 of carbolic acid, which dissolved in twenty parts 
 of water. By the use of this watery dilution he 
 had been able to diminish the caustic effect of 
 the carbolic and had kept operative wounds clean 
 and healthy. But the subject of the manage- 
 ment of operations was a vast one and far more 
 complicated than the treatment of compoimd 
 fractures and abscesses. Lister, therefore, held 
 his peace imtil he could be more definite. 
 
 The danger of operations undertaken in public 
 hospitals was exceedingly great. Indeed, there 
 was little that showed so m.arkedly what death- 
 traps these institutions of charity were. Lister 
 was not the only surgeon whO' was appalled at 
 the gulf which separated profession and practice. 
 Sir James Simpson, the famous discoverer of 
 the ansesthetic powers of chloroform, was equally 
 impressed that the surgical hospital bore an 
 ominous resemblance to a slaughter-house. 
 Lister, convinced of this character of the hospital, 
 had pondered over the matter and found its 
 solution. Simpson, the victor of a famous con- 
 troversy as to the justification of anaesthesia, 
 armed himself to convince both the profession 
 
 129 I 
 
Lord Lister 
 
 and public of a truth which familiarity and in- 
 difference had obscured. 
 
 The operations which were most commonly 
 undertaken were amputations. They were some- 
 times imperative, and only the imperative opera- 
 tion was dared in the hospital if the building 
 harboured the usual fell blood-poisonings. 
 Simpson wrote round to the practitioners in 
 Great Britain and collected statistics of ampu- 
 tations undertaken in country practice where a 
 hospital was not available. He published his 
 results in 1869, two years after Lister had first 
 announced the virtues of antisepsis. 
 
 In all he collected reports of 2,098 amputa- 
 tions, of which 226, or i in every 9, died. The 
 most serious amputations were those undertaken 
 through the thigh on account of injury. Of 
 these I in every 4 died. 
 
 'He then collected from the Edinburgh and 
 Glasgow Infirmaries and the L'ondon Hospitals 
 reports of 2,089 amputations. Of these 855 
 ended in death, or 2 in every 5 . Of amputations 
 made through the thigh on account of injury, 
 2 in every 3 resulted in death. Nor was thte 
 toll of death the only measure of disaster. There 
 were no statistics which could tell of the un- 
 speakable agony patients suffered as the gan- 
 grene gnawed at the living flesh, of the sharp 
 cries of pain and the tragic prayers breathed to 
 the Divine mercy for the speedy gift of death. 
 
 Even the operations undertaken outside the 
 precincts of a hospital showed too many victims 
 
 130 
 
The Way to Perfection 
 
 due to poisonous germs implanted in the wound 
 by the fingers, instruments, and dressings of the 
 administrating surgeon. Over a quarter of the 
 deaths outside the hospital were due to these 
 germs, and in the light of modern knowledge 
 probably many more. But the notable fact 
 which had been strangely overlooked and for 
 which Simpson demanded general attention, was 
 that hospitals, and especially the large ones, were 
 places where these diseases were bred to a fearful 
 state of virulence, a fact demonstrated in the 
 modern laboratory, where it has been shown that 
 as microbes pass successively from victim to 
 victim they increase in virulence. 
 
 " The tremendous differences between the two 
 practices," wrote Sir James in concluding his 
 essay, " may perhaps be more pointedly and 
 simply stated thus :— 
 
 Out of 2,089 amputations in hospital practice 855 died 
 Out of 2,098 amputations in country practice 226 died 
 
 Giving an excess in hospital practice of 629 deaths 
 
 "This excess in about 2,100 amputations of 
 629 deaths in hospital practice as compared with 
 rural practice— in our palatial hospitals as com- 
 pared with our rural villages and cottages, in 
 large wards as compared with isolated rooms- 
 is certainly much greater and more pronounced 
 than I myself expected when I began the present 
 inquiry. But must the calling of this dismal 
 
 131 
 
Lord Lister 
 
 death-roll go on unchallenged and unchecked? 
 Shall this pitiless and deliberate sacrifice of 
 human life to conditions which are more or less 
 preventable be continued or arrested? Do not 
 these terrible figures plead eloquently and 
 clamantly for a revision and reform' of our 
 existing hospital system?" 
 
 Howsoever carefully statistical evidence has 
 to be sifted, yet the large set of figures and 
 striking differences which Simpson obtained laid 
 bare the deadly nature of hospitals in an un- 
 deniable manner. Nevertheless there arose an 
 abundance of deniers and repudiators. No pro- 
 fession will allow its good intentions to be 
 demonstrated as being pernicious in practice. 
 No body of men cares to have it shoAvn that their 
 good will is more notable than their good sense. 
 No doubt the surgeons of that day did their 
 best, but " doing their best " may have condoned 
 but did not destroy the ill-effects of incompetent 
 workers. Until Lister came, hospital surgeons, 
 despite their operative skill, were gravely incom- 
 petent ; and the one great lesson taught by 
 Lister's salvation of the hospitals is that it is 
 imperatively necessary for genius to guide man- 
 kind through the treacherous paths of ill- 
 instructed charity. 
 
 There were, however, some who joined with 
 Simpson in protesting against the hospital. 
 " Must hospital surgeons ever remain content 
 with losing one-third to one-half of all their 
 amputation cases, and nine -tenth's of some ? " 
 
 132 
 
The Way to Perfection 
 
 asked Erichseiij aghast at the results of his 
 inquiry into "hospitalism",; and Mr. Cadge, of 
 Norwich, declared that " although a hospital may 
 not be the mother of pyaemia, it is its nurse." 
 Such supporters were, nevertheless, few. 
 
 The orthodox, on the other hand, were out- 
 raged by Simpson's heresy. The hospitals were 
 the very temples of their faith and rites. Mr. 
 Holmes voiced the outcry at Simpson's " heavy 
 charge " against the hospitals—" no less than that 
 of deliberately sacrificing the lives they were 
 instituted to preserve." So indignant were the 
 orthodox that it is more than doubtful if the 
 accusers of hospitals could ever have destroyed 
 this system of the collective treatment of the 
 sick. One thing that made such an abolition 
 peculiarly difficult was the increase of indus- 
 trialism, which not only crowded men together, 
 but also greatly increased the number of acci- 
 dents. Large hospitals in the centre of these 
 growing industrial towns seemed indispensable. 
 At any rate, they were erected in numbers and 
 subscribed to by the wealthy and benevolent. 
 Others were enlarged. Provision against acci- 
 dent was in this way made, and the result was 
 that the dangers of accident were enormously 
 increased. The horrors of the early days of 
 industrialism have often been depicted, but the 
 hospital side of the gloomy picture is little 
 known. It was terrible. It made the need of 
 a Lister especially urgent. Hospitals previous 
 to industrialism were not such fearful death-traps 
 
 133 
 
Lord Lister 
 
 as they then became. The statistics of the pre- 
 industrial days were not carefully kept^ but such 
 as they were they showed that the old hospitals 
 were three or four times as healthy as the palatial 
 buildings erected in the new industrial centres. 
 
 What was to be done? Sir James Simpson, 
 amidst a loud chorus of protest, boldly declared 
 that the large hospitals must be utterly destroyed 
 and replaced by a large number of huts, each 
 hut lodging one or at the most two patients, and 
 further that these " villages " should be built 
 of iron instead of brick and stone, so that they 
 could be taken down and rebuilt every few years . 
 Erichsen, less bold and radical, gave a list of 
 seventeen rules to be followed in hospitals by 
 which " much may be done to lessen the mor- 
 tality from septic surgical diseases in hospitals." 
 Most surgeons, however, possessed and desired 
 only blind eyes when turned upon the spectre 
 of disease, and some of the leaders flatly declared 
 that they did not believe Simpson's figures were 
 true, and if they were true that they did not 
 believe the deductions made from them. Even 
 Erichsen joined the latter party and Simpson 
 seemed to stand alone. 
 
 But there could not have been a mightier 
 champion of a cause than Sir James. The name 
 of the discoverer of chloroform loomed large in 
 the eyes of the public, and when he came forth 
 with his great accusation the public at least 
 turned an attentive ear. With the shrewd instinct 
 it has for those things that concern its welfare 
 
 134 
 
The Way to Perfection 
 
 and with an equally shrewd instinct as to the 
 prejudices of a profession, whether scientific or 
 theological, the public forced an inquiry. 
 
 In consequence the matter was taken up at 
 the thirty-seventh meeting of the British Medical 
 Association, held in 1869 at Leeds. The meet- 
 ing showed vividly what a bomb Simpson had cast 
 into the midst of the profession by the publication 
 of his figures. Many of the surgeons attendant 
 upon the hospitals from which Simpson had 
 drawn his figures felt that a personal affront 
 had been done to them. The diseases which they 
 regarded as the inevitable sequences of nature 
 were now by the audacious Simpson declared to 
 be disasters for which they and their hospitals 
 were personally responsible. Other surgeons, 
 such as Mr. Jonathan Hutchinson, by making 
 general remarks as to the difference between 
 town and country, thought to throw discredit 
 upon the figures. Others brought out little lists 
 of successes, which they thought, David-like, 
 might slay the giant Simpson had erected. 
 Professor Bennett, a colleague of Simpson's at 
 Edinburgh, and another of the famous fighters 
 of that University, caustically remarked amid 
 loud remonstrances that he was one of the ex- 
 tremely rare medical philosophers who definitely 
 cared for the truth, and proceeded to say that 
 Simpson's statistics were fallacious and the dawn- 
 ing belief in the existence of germs pitiable. 
 Altogether the debate was of such a character 
 as to be found by the Lancet to be " satisfactory 
 
 13s 
 
Lord Lister 
 
 and reassuring " and bp show that " there is no 
 ground whatsoever in any facts which have been 
 satisfactorily proved for the general outcry which 
 it has been attempted to raise against hospitals of 
 moderately large size to supply the wants of 
 large populations." 
 
 So in spite of the foetid atmosphere of the 
 wards in which surgeons worked, in spite of the 
 vigorous eloquence of Sir James Simpson's 
 speeches at this meeting— speeches which, if read 
 to-day, still ring with a splendour of insight and 
 conviction and a high superiority above those 
 of other speakers— in spite of the fact that thfe 
 faith of some surgeons in their hospitals was 
 shaken by Simpson's bomb, it seems certain that 
 the view of the Lancet that all was well with the 
 hospitals would have prevailed, and at the most 
 only little by little would improvements have 
 been effected. 
 
 A few tentativie and sceptical remarks were 
 made upon Lister's work at this meeting. Only 
 one surgeon— Mr. Macleod— spoke emphatically 
 in its favour, and he was one of Lister's col-i 
 leagues at Glasgow Infirmary. Sir James 
 Simpson himself gave a few words to this aspect 
 of the question : "I am rather hopeless of the 
 evils of hospitalism being cured by any such 
 agent as carbolic acid." 
 
 Meanwhile, Lister kept outside all this con- 
 troversy. Convinced that he had the clue to 
 hospitalism, he could afford to ignore figures 
 and set himself to building up the hospitals anew. 
 
 136 
 
The Way to Perfection 
 
 It was the best thing to do. Had the movement 
 which Simpson attempted to arouse succeeded, as 
 in those days it ought, upon its merits, to have 
 succeeded, all the big hospitals might have been 
 pulled down with as great a zeal as once despoiled 
 the Catholic churches. Indeed, in Prussia the 
 process had already begun . Large hospitals were 
 being abandoned and hut hospitals substituted. 
 Lister's work, then, came in the nick of time. 
 It saved not only patients but hospitals. It 
 prevented a very heavy expenditure of public 
 money and an entire reversion of the method 
 of dealing surgically with the poor. In the 
 light of events, then, one can be grateful to 
 the obtuse conservatism of Sir James Simpson's 
 critics and opponents. 
 
 Lister, having proved himself victorious over 
 compound fractures, abscesses, and accidental 
 wounds, now set himself to prove that death 
 could be beaten back from patients who had to 
 submit to the knife. 
 
 Lister, as has been said, declared himself, at 
 Dublin in 1867, discontented with his methods 
 of dealing with the problem' of operations : "I 
 have not as yet pleased myself altogether 
 with any of the methods I have employed. I 
 am, however, prepared to gO' so far as to say 
 that a solution of carbolic acid in twenty parts 
 of water, while a mild and cleanly application, 
 may be relied on for destroying any germs that 
 may fall upon the wound during an operation." 
 A fe'w months later, relying on solutions of 
 
 137 
 
Lord Lister 
 
 carbolic, he did a thing no other surgeon would 
 have dared to do. To straighten a foot that had 
 been rendered useless by an accident, he opened 
 the ankle-joint. "This," he said, "I should 
 not have dreamed of doing without the aid of 
 the antiseptic system, being well aware of the 
 disastrous course such injuries commonly run 
 under ordinary management." He and his 
 dressers first made everything scrupulously clean, 
 and hands, instruments, sponges, etc., were 
 purified with carbolic solution. The wound, 
 throughout the operation, was wetted with watery 
 carbolic and finally dressed with carbolic oil. 
 The operation was, in fact, carried out with an 
 antiseptic technique which was thorough if not 
 refined. The result was a complete success, and 
 in a short space of time the patient was able to 
 walk " firmly and well." 
 
 But though such cases were encouraging, there 
 was one great hindrance to Oiperations, and 
 especially such operations as amputations, doing 
 well. This was the question of stopping the 
 blood flow from the severed arteries. 
 
 The profession had, of course, long given up 
 the barbarous method of plunging the stump 
 of an amputated limb into boiling oil. The 
 great French surgeon Ambroise Pard (1510-90) 
 introduced the ligature of arteries, and his 
 method of stopping bleeding had been generally 
 adopted. A piece of silk or whipcord was passed 
 round the cut end of the artery and tightly tied. 
 But the ligature, though better as a method of 
 
 138 
 
The Way to Perfection 
 
 stopping the bleeding than boiling oil, had a 
 grave disadvantage— it did not melt away in the 
 tissues and it was not germ -free. Consequently, 
 it always led to suppuration, and this suppura- 
 tion always continued until it was removed. The 
 method of removal was to leave the long ends 
 of it hanging out from the wound and to wait 
 until the knot had rotted through the artery. The 
 ligature was then pulled away, and the artery 
 was left closed by the bload-clot that had formed 
 within it. As a consequence of the ligatures, 
 no wound in which an artery, was tied cO|Uld 
 possibly heal without suppuration, and suppura- 
 tion once established frequently did not cease 
 with the removal of the ligature, but continued 
 to waste the patient's strength. There was, 
 moreover, a further danger. Sometimes the 
 blood-clot which formed in the tied artery also 
 became seriously involved in the suppuration ; 
 it began to soften, and became loose. A 
 terrible rush of blood would result— the so-called 
 secondary haemorrhage— a sudden rush which 
 frequently killed the patient before any attendant 
 could get to him. Ligatures, therefore, not only 
 caused inevitable suppuration, but they also in- 
 volved the danger of this dreadful, sudden flow 
 of blood. But both events were regarded by 
 the mass of the profession with the indifference 
 that is shown to the inevitable in others. Some 
 surgeons, seeing nothing but good in their 
 own works, went even farther, and actually, 
 congratulated themselves upon the excellent 
 
 139 
 
Lord Lister 
 
 paths for discharge these .filthy, bits )of silk 
 provided. 
 
 The stronger men of the profession, able in 
 the consciousness of their power to submit them- 
 selves and their work to a more drastic criticism, 
 recognized the evil of thfese foreign bodies in 
 the healing flesh. The great John Hunter and 
 Sir William Lawrence both declared suppuration 
 to be inevitable as long as ligatures were inevit-. 
 able. The latter recomtaended, as a measure 
 of relief, that ligatures ' should be cut short, only 
 the part that surrounded the artery being left,, 
 and the wound closed. But this led so frequently 
 to deep abscesses, necessitating the re-opening 
 of the wound, that Lawrence abandoned it . Other 
 surgeons tried animal ligatures made out of 
 sheep's gut (the so-called catgut) or of the sinews 
 of deer, in the hope that these ligatures would get 
 absorbed in the wound without trouble. Others, 
 Dr. Levert, of Alabama, being the innovator, 
 used fine metal wire for ligatures. These wire 
 ligatures were the most successful, for metal 
 cannot soak up juices and harbour germs as 
 does silk or thread. Nevertheless, they often 
 caused suppuration, and more frequently 
 neuralgic pains, and had to be cut out. The 
 subject of ligatures, in fact, seemed insoluble 
 before Lister took the matter in hand. The 
 profession regarded the silk or thread ligatures 
 with the long ends lying outside the wound as 
 orthodox, and, as has been said, not infrequently 
 converted their vice in causing suppuration into 
 
 140 
 
The Way to Perfection 
 
 the virtue of providing paths of exit for the dis- 
 charge they themselves caused. The question, 
 indeed, was regarded in the same light as that 
 of the hospitals. 
 
 The resemblance was very close, for in this 
 matter, too, in the sixties, the profession was 
 divided into three groups. One division, the 
 largest, consisted of the profession as a whole, 
 following contentedly, or perforcedly the orthodox 
 method. The other two divisions, the important 
 ones, consisted of two men, Joseph Lister and 
 Sir James Simpson. The latter gentleman, with 
 characteristic force and eloquence, was telling 
 surgeons that by strangulating the arteries with 
 ligatures they were sowing their wounds " with 
 morsels of dead flesh." He had been impressed 
 by the comparative success of wire ligatures and 
 by the " tolerance of metallic bodies by the living 
 tissues of the body." As a consequence, after 
 prolonged and careful research extending over 
 some years, he devised an ingenious method of 
 temporarily compressing cut arteries until the 
 blood in them firmly clotted, between long 
 needles thrust in various ways into the wound. 
 The needles were in a few days withdrawn. This 
 system he called acupressure. The old system 
 of ligatures, like the old system of hospitals, he 
 wanted utterly abolished. Indeed, he prophesied 
 that within two or three generations ligatures 
 would be abolished and acupressure would be 
 the orthodox and successful method of stopping 
 haemorrhage, and he ended his plea for acu- 
 
 141 
 
Lord Lister 
 
 pressure with a caustic comtaent upon his pro- 
 fessional brethren : " It is mere idleness and 
 frivolity, to argue, as has been lately and earnestly 
 done, that no efforts should be made in this 
 direction, because surgeons are generally quite 
 content with the ligature, in despite of its evils, 
 and have no wish to change." Such was the 
 vigour of his accusation, which aroused strong 
 resentment amongst the surgeons, so that James 
 Syme, in the presence of his students, denounced 
 Simpson's " vulgar insolence " and tore up and 
 flung away the pamphlet sent to him by its 
 distinguished author. 
 
 Lister again took no part in the controversy, 
 but gave a great deal of thought and study to 
 the question of ligatures. He saw at once that 
 it was the decomposition of the fluids lying 
 stagnant in its interstices that rendered the silk 
 so noxious. But it was not until the antiseptic 
 method, by its success, gave him time for con- 
 centrated thought and experiment that Lister 
 began to see light, and began to establish the two 
 methods of ligaturing that have now become 
 the orthodox practice of the profession. 
 
 The first clue to the ultimate triumph was 
 one the significance of which probably would 
 have escaped any other medically, trained eye 
 except Lister's in all Great Britain ; and in the 
 measure of men it is this astonishing immediacy 
 of understanding of the first principles of Nature 
 which lifts Lister to the rank of genius . Simpson 
 was the greatest practical mfedical man of the 
 
 142 
 
The Way to Perfection 
 
 time, taking facts as they stood and acting upon 
 them. He saw that in the hospitals disease bred 
 to virulence ; therefore, he said, destroy the 
 hospitals. He saw that the wire ligature did 
 not irritate like silk, and devised acupressure. 
 But Lister was something more than a practical 
 man. He read the mysteries of Nature anew. 
 He was the interpreter of Nature to man, the 
 vpo<f)rJTr)^ of the Greeks, and based himself upon 
 an actual observation of what Nature herself did. 
 
 The clue occurred in the third case of com- 
 pound fracture treated by the antiseptic method. 
 Lister was lifting up a piece of the crust formed 
 by the blood and carbolic when he noticed a little 
 cavity in it filled with brownish fluid. To the 
 ordinary eye this would have meant nothing. 
 Such cavities not uncommonly form in crusts and 
 scabs. But on touching the wall of the little 
 cavity Lister noticed that it bled ; in other words, 
 it was alive, for only that which is alive can 
 bleed. What, then, had happened? A cavity 
 had formed in a crust of blood and carbolic acid 
 —that is to say, in matter which was dead. Yet 
 by some strange magic this same matter in which 
 the cavity had formed had now become alive. 
 Lister saw at once that the living tissues had 
 eaten into and replaced the dead matter around 
 the cavity. Lister stored up in his mind this 
 discovery of this hitherto unknown power of the 
 tissues . 
 
 His fifth case, of the " fine, intelligent boy, 
 seven years of age," gave him a more extended 
 
 H3 
 
Lord Lister 
 
 view of this power of Nature. A piece of dead 
 bone was always believed by surgeons to crumble 
 and exfoliate, and discharge itself in fragments 
 through a wound in the skin. In the case of 
 this boy, Lister observed a piece of dead bone 
 in a wound kept pure and at rest with carbolic 
 acid. On removing the dressing one day, Lister 
 was surprised to find the bare white bone covered 
 with a thin, pink flesh. Moreover, when he 
 touched the bone with a probe, he found it as 
 frail and honeycombed as the paper of a wasp's 
 nest. The living tissues had already eaten most 
 of the dead bone up, and were eating the rest 
 up too. Lister again carefully noted this new 
 natural power. On brooding over it, he saw 
 that the question of ligatures could be solved. 
 
 If the living tissues could eat up dead bone 
 and dead blood-crust, wh,y, should they not also 
 eat up some form of ligature, if the ligature was 
 kept free of microbes, and so the living tissues 
 about it were able to perform their natural func- 
 tions ? If the ligature was eaten up, then there 
 would no longer be any need for long threads 
 to be left hanging out of the wound. The ends 
 of the ligature could be cut short and the wound 
 closed and the ligature left to be absorbed by 
 the tissues. Such wounds, then, as those of 
 amputation might be made to close as rapidly 
 as a cut finger. Lister quietly wondered whether 
 " this particular branch of the subject will yield 
 all that it promises." 
 
 No innovation such as Lister projected is first 
 
 144 
 
The Way to Perfection 
 
 tested by a surgeon upon man. A horse in a 
 veterinary, establishment needed operation . Lister 
 was informed, and used the opportunity to tie 
 the artery in the horse's neck with a silk hgature 
 which had been soaked for two hours in a solution 
 of carbolic. The ends of the ligature were cut 
 short and the wound entirely closed over them. 
 What would happen beneath ? Would the tissues 
 eat up the silk? Lister waited for ten days, and 
 then removed the antiseptic dressing. All was 
 well ; the experiment had apparently succeeded. 
 In five weeks, however, the horse died. Lister 
 was able to examine the ligature he had tied; 
 it was qviite healthy. Thfe silk itself was bridged 
 over by new tissue, but it was not absorbed or 
 eaten up. The time, it is true, had been brief; 
 nevertheless, the silk was quite unchanged, as 
 unchanged as a wire ligature. Still, the result 
 was satisfactory. It was better to have soft 
 silk buried in the neck than hard wire. An 
 advance had been made, but the perfect result 
 of the absorbable ligature had not been 
 obtained. 
 
 Lister was emboldened by this success to 
 attempt a buried silk ligature in a human being. 
 The case he chose was not a favoiu-able one. 
 A lady suffered from a gluteal aneurysm— that 
 is to say, from a saccular enlargement of the 
 large artery of the buttock. Such an enlarge- 
 ment is scarcely an indication of a healthy artery. 
 Nevertheless, Lister made his first htunan trial 
 
 upon this diseased artery. 
 
 145 K 
 
Lord Lister 
 
 The whole operation was carried out with care- 
 ful antisepsis. The silk ligature was first soaked 
 for two hours in a concentrated solution of 
 carbolic, and was then transferred to a weaker 
 solution. This was done to dilute the carbolic 
 and weaken its caustic effect upon the tissues,, 
 for, as Lister said, " the less the antiseptic comes 
 in contact with the living tissues the better, so 
 that unnecessary disturbance from its irritating 
 properties may, be avoided." Lister used the 
 same dilute acid for his instruments, the sponges, 
 and washing out the wound. 
 
 The patient did well. Previous to the opera- 
 tion she had been " in agony." After the 
 operation she lived for about ten months " in 
 fair health and strength." She then died sud- 
 denly. The disease of her arteries had been 
 general. Another aneurysm', one in the chest, 
 had btirst, and she bled to death into her own 
 body. Lister made a post-mortem examination. 
 He found the silk ligature around the artery only 
 a little altered. The knot was a little eroded, 
 the cut ends a little shorter, the loop a little 
 thinner. The absorption was so slight that Lister 
 was mostly surprised at the silk's resistance to 
 being eaten up. Lister carefully examined every- 
 thing with the microscope. He tracked the fate 
 of the minutest thread. 
 
 Lister had not achieved his object with the 
 silk. He turned to the so-called animal ligatures, 
 which had once been tried by the profession 
 and had been abandoned. Catgut, a thread made 
 
 146 
 
The Way to Perfection 
 
 from sheep's gut, was the one he chose. This 
 he soaked in carboHc oil. With the same anti-' 
 septic precautions he tied the large artery of 
 the neck of a calf. At first the catgut snapped^ 
 but eventually, with a less brittle thread. 
 Lister succeeded. All went well, and a month 
 later the calf was killed. He examined the 
 artery. To his great disappointment the liga- 
 ture apparently had not altered. He examined 
 it more closely, and his keen eye observed that 
 " the dirty grey of the softened catgut had turned 
 to a dirty pink." The pink was the flush of 
 early life. Under his microscope he saw this 
 clearly. The Jigature had been penetrated and 
 replaced by living tissue. The form had 
 remained the same, but Lister's Galatea had 
 become suffused with life. He quietly announced 
 his victory over the baffling problem of the liga- 
 ture. " In this form " (carbolized, and with anti- 
 septic treatment of the wound) " the gut seems 
 almost a perfect material for the ligature under 
 any circumstances in which it is required." 
 
 But Lister was not yet finished. It was a 
 characteristic of his never to rest until he had 
 completed a task which he had taken up . Lesser 
 matters of the day always had to be completed, 
 though the midday meal were deferred until late 
 afternoon and the evening meal to the hours 
 about midnight. Larger tasks were pursued with 
 a like pertinacity before Lister would rest. His 
 gifts were never partial ; they were complete 
 and perfect ; they needed no additions from the 
 
 147 
 
Lord Lister 
 
 hands of other masters. Lister therefore deter- 
 mined to eliminate the word " almost." Catgut 
 should no longer be " almost perfect " as a liga- 
 ture ; it should be as perfect as Nature herself, in 
 the making of sheep's gut, would allow. 
 
 Its defect was the defect from which he him- 
 self had suffered when operating upon the calf. 
 Soaking it in carbolic caused it to soften and to 
 snap when the knot was being tied. Further 
 softening occurred, due to the imbibition of the 
 juices of the tissue, so that there was a risk of 
 the ligature failing to hold the artery efficiently. 
 Lister was not able to overcome these defects 
 whilst he was Professor of Surgery at Glasgow. 
 The work occupied him for another twelve years. 
 During that time he visited factories where cat- 
 gut was prepared and mastered the whole process 
 of its preparation, from its origin to its 
 completion. Basing himself upon the knowledge 
 he gained of the original scraping, twist, drying, 
 seasoning, etc., of the catgut, he carried out 
 " hundreds of experiments," each one of which 
 " added something to my knowledge of it." His 
 knowledge of chemistry, preserved since the days 
 when he was a favourite pupil of Graham at 
 University College, stood him in good stead. He 
 himself carefully tested all the chemicals he 
 needed, and described their advantages and 
 defects. He also investigated the mechanical 
 qualities of catgut and the effects of tension and 
 strain ; he tested the effect of age upon it. There 
 was, indeed, no possible thing, either trifling 
 
 148 
 
The Way to Perfection 
 
 practical detail or profound mystery of Nature, 
 bearing upon the matter, from the time the gut 
 left the sheep to the time it was eaten up and 
 replaced by, the living tissue of the body, that 
 he did not personally master. The final result 
 of his labours was the chtomic gut which the 
 surgeon and student handle to-day, not cogni- 
 zant, as a rule, of the evidence it is to the original 
 creative quality of genius, which bases itself 
 directly upon Nature and direct observation, and 
 never upon the teachings of mankind. 
 
 149 
 
CHAPTER VII 
 
 THE MIRACLE 
 
 Sir James Simpson, in his attack upon 
 hospitalism, gave, among other statistics, those 
 of the amputations carried out at Glasgow 
 Infirmary between 1847 and 1868. They had 
 the distinction of being equal to the worst. 
 Glasgow Infirmary, in fact, had an evil reputa- 
 tion, and so peculiarly evil a situation, that it 
 seemed as if it had been specially designed in 
 order most rigorously to test Lister's attack upon 
 disease. No more unfavourable conditions could 
 well be imagined. Yet Lister's triumph was com- 
 plete. The conditions under which it was won 
 cannot be better given than in his own words. 
 The quotation is a long one from a paper pub- 
 lished in 1870, but its sedate account of the 
 turning-point of all surgery should make the 
 words classical : — 
 
 " The antiseptic system has now been in opera- 
 tion sufficiently long to enable us to form a fair 
 estimate of its influence upon the salubrity of 
 a hospital. Its effects upon the wards lately 
 under my care in the Glasgow Infirmary were 
 
 in the highest degree beneficial, converting them 
 
 150 
 
The Miracle 
 
 from some of the most unhealthy in the king- 
 dom into models of healthiness. The interests 
 of the public demand that this striking change 
 should be generally known." Lister continued 
 with a particular description of the infirmary and 
 the new wing erected in i860: "To the great 
 disappointment of all concerned, this noble 
 structure proved extremely unhealthy. Pyaemia, 
 erysipelas, and hospital gangrene soon showed 
 themselves, affecting, on the average, most 
 severely those parts of the building nearest to 
 the ground, including my male accident ward, 
 which was one of those on the ground floor, 
 while my female ward was immediately above. 
 For several years I had the opportunity of 
 making an observation of considerable, though 
 melancholy, interest — viz., that in my accident 
 ward, where all or nearly all the beds contained 
 patients with open sores, the diseases which result 
 from hospital atmosphere were sure to be present 
 in an aggravated form ; whereas, when a large 
 proportion of the cases had no external wound, 
 the evils in question were greatly mitigated or 
 entirely absent. This appeared striking evidence 
 that the emanations from foul discharges, as dis- 
 tinguished from the mere congregation of several 
 human beings in the same apartment, constitute 
 the great source of mischief in a surgical hospital . 
 Hence I came to regard simple fractures, though 
 almost destitute of professional interest to myself 
 and of little value for clinical instruction, as the 
 greatest blessings ; because, having no external 
 
 151 
 
Lord Lister 
 
 wound, they diminished the proportion of con- 
 taminating cases. At this period I was engaged 
 in a perpetual contest with the managing body, 
 who, anxious to provide hospital accommoda- 
 tion 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, fairly attributable 
 to the firmness of my resistance in this matter 
 that, though my patients suffered from the evils 
 alluded to in a way that was sickening and often 
 heartrending, so as to make me sometimes feel 
 it a questionable privilege to be connected with 
 the institution, yet none of my wards ever 
 assumed the frightful condition which sometimes 
 showed itself in other parts of the building, 
 making it necessary to shut them up entirely 
 for a time. A crisis of this kind occurred rather 
 more than two years ago in the other male 
 accident ward on the ground floor, separated from 
 mine merely by a passage twelve feet broad ; 
 where the mortality became so excessive as to 
 lead, not only to closing the ward but to an 
 investigation into the cause of the evil, which was 
 presumed to be some foul drain. An excava- 
 tion made with this view disclosed a state of 
 things which seemed to explain sufficiently the 
 unhealthiness that had so long remained a 
 mystery. A few inches below the surface of 
 the ground, on a level with the floors of the 
 two lowest male accident wards, with only the 
 
 152 
 
GLASGOW INFIRMARY. 
 
 The wards where Listc-r worked his miracle were in the liinder building 
 {Block lent by Ihe Injiniuiiy.) 
 
The Miracle 
 
 basement area, four feet wide, intervening, was 
 found the uppermost tier of a multitude of 
 coffins, which had been placed there at the time 
 of the cholera epidemic of 1849, the corpses 
 having undergone so little change in the interval 
 that the clothes they had on at the time of their 
 hurried burial were plainly distinguishable. The 
 wonder now was, not that these wards upon the 
 ground floor, had been unhealthy but that they 
 had not been absolutely pestilential. Yet at the 
 very time when this shocking disclosure was 
 being made I was able to state, in an address 
 which I delivered* to the meeting of the British 
 Medical Association in Dublin, that during the 
 previous nine months, in which the antiseptic 
 system had been fairly in operation in my wards, 
 not a single case of pyaemia, erysipelas, or 
 hospital gangrene had occurred in them ; and 
 this, be it remembered, not only in conditions 
 likely to be pernicious but at a time when the 
 unhealthiness of other parts of the same build- 
 ing was attracting the serious and anxious atten- 
 tion of the managers. Supposing it justifiable 
 to institute an experiment on such a subject, it 
 would be hardly possible to devise one more 
 conclusive." 
 
 Nor was this the whole extent of the 
 peculiarities with which the site of the hospital 
 was endowed : " Besides having along one of 
 its sides the place of sepulture above alluded 
 to, one end of the building is conterminous 
 with the old cathedral churchyard, which is of 
 
 153 
 
Lord Lister 
 
 large size and mucb used, and in which the 
 system of ' pit burial ' of paupers 'has hitherto 
 prevailed. I saw one of the pits some time 
 since, having been requested to report upon it 
 by one of the civic authorities, who is also a 
 manager of the infirmary, and who, having acci- 
 dentally discovered what was going on, at once 
 took steps to prevent for the future the occur- 
 rence of anything so disgraceful. The pit, which 
 was standing open for the reception of the next 
 corpse, emitted a horrid stench on the removal 
 of some loose boards from its mouth. Its walls 
 were formed, on three sides, of coffins piled upon 
 one another in four tiers, with the lateral inter- 
 stices between them filled with human bones, the 
 cofiins reaching up within a few inches of the 
 surface of the ground. This was in a place 
 immediately adjoining the patients' airing- 
 grotmd, and a few yards only from the 
 windows of the surgical wards. And the pit 
 which I inspected seems to have been only one 
 of many similar receptacles, for the Lancet of 
 September 25th contains a statement, copied 
 from one of the Glasgow newspapers, that ' the 
 Dean of Guild is said to have computed that five 
 thousand bodies were lying in pits, holding eighty 
 each, in a state of decomposition, around the 
 infirmary,' Just beyond the churchyard rises an 
 eminence covered by an extensive necropolis, 
 which, however, from its great distance, must 
 have comparatively little deleterious influence. 
 When I add that what is called the fever hospital, 
 
 1 54 
 
The Miracle 
 
 a long four-storied building, extends at right 
 angles to the new surgical hospital, separated 
 from it by only eight feet, and that the entire 
 infirmary, containing 584 beds, stands upon an 
 area of two acres, and that the institution is 
 almost full to overflowing, I have said enough 
 to show that the wards at my disposal have been 
 sufficiently trying for any system of surgical 
 treatment. Yet during the two years and a 
 quarter that elapsed between the Dublin meeting 
 and the time of my leaving Glasgow for 
 Edinburgh those wards continued in the main 
 as healthy as they had been during the previous 
 nine months. Adding these two periods together, 
 we have three years of immunity from the ordi- 
 nary evils of surgical hospitals, under circum- 
 stances which, but for the antiseptic system, were 
 especially calculated to produce them," 
 
 Such was the character of Lister's triumph, 
 achieved in the very camp of the enemy, Simpson 
 had desired to abolish these disease -breeding 
 hospitals. He was the reformer who destroys. 
 Lister was the reformer who reconstructs. From 
 wards in which the foul emanations of the dead 
 coming through the windows mingled with the 
 foul emanations of the living Lister established 
 " models of healthiness," 
 
 In the summer of 1869 James Syme suffered 
 from an apoplectic stroke. He recovered with 
 partial paralysis, but of course felt compelled to 
 resign his professorship. He had watched the 
 career of his son-in-law with increasing pride 
 
 15s 
 
Lord Lister 
 
 and admiration, and was the first of the old 
 school of surgeons to recognize Lister's great- 
 ness. Lister and his wife used frequently to 
 journey to Edinburgh, and Lister, therefore, was 
 able to have long conversations and consultations 
 with the great Edinburgh surgeon. Syme tried 
 the antiseptic system in his own wards and was 
 soon convinced of its value. In 1869 he pub- 
 lished seven remarkable successes in the British 
 'Medical Journal, and brought all his powerful 
 influence to aid the recognition of the new work. 
 His fighting spirit was also aroused by those 
 jealous antagonists who have always to be beaten 
 back when a great discovery is made. Carbolic 
 acid had been used before Lister's day to take 
 away odours. Lister himself had had his atten- 
 tion drawn to its possibilities by its usage in 
 Carlisle for these purposes. But its use to take 
 away smells was very different to the use to 
 which Lister put it, and the blundering attempts 
 to put his great work on a par with the work 
 of those who used carbolic acid as a deodorant 
 aroused the f>otent wrath of James Syme to de- 
 nounce those who would " filch away from Mr. 
 Lister the credit justly due to him for devising 
 and establishing the antiseptic system." Finally, 
 in the last clinical lecture he delivered before 
 his stroke, he announced with prophetic vision 
 his faith in the younger surgeon who " is 
 certainly destined in no small measure to revo- 
 lutionize the practice of surgery." 
 
 Syme recovered from his stroke sufficiently to 
 
 156 
 
The Miracle 
 
 once more come out in support of his son-in- 
 law. He was emphatic in his advocacy of Lister 
 fining the post he himself had been compelled 
 to resign. Lister was accordingly appointed 
 Professor of Clinical Surgery in Edinburgh 
 University in succession to Syme in 1869, and 
 it was consequently from Edinburgh that he 
 published the story of his triumph. 
 
 No sooner had Lister announced this triumph 
 than he was attacked. The first attack seems to 
 us now more amusing than anything else. It 
 was not until Lister had returned to Edinburgh 
 that, in giving an accoxmt of the wonders the 
 antiseptic system had wrought in his wards at 
 Glasgow, he had been compelled to show how 
 very adverse the situation of those wards had 
 been to surgical cleanliness and success. This 
 exposure of the scandalous site of the leading 
 hospital in Glasgow was certainly something of 
 a Parthian shot. 
 
 The directors of the Glasgow Infirmary were 
 but ordinary mortals — that is to say, men so 
 boimd by habit as to be unable to see truly any 
 great change that was taking place under their 
 own eyes. The habit in their case seems to 
 have been an economical one. Lister's antiseptic 
 dressings were, of course, more costly than lint 
 dipped in water, which constituted the common 
 wet dressing. This expense of the dressings had 
 somehow to be counterbalanced. By good 
 fortune the healthy conditions of Lister's wards 
 enabled them to effect this. They were so 
 
 157 
 
Lord Lister 
 
 healthy that with a clear conscience the directors 
 were able to save upon the usual cleaning. " My 
 wards have remained," wrote Lister, " during the 
 three years without the annual cleaning which 
 used to be thought essential. On my asking 
 the superintendent the reason for the omission, 
 he replied that as those wards had continued 
 healthy, and there was nothing dirty in their 
 appearance, it had seemed unnecessary to disturb 
 them." 
 
 Lister, in spite of this lack of appreciation, 
 had felt a considerable reluctance in making the 
 true conditions of the Glasgow Infirmary public. 
 But the bearing it had upon his discovery was 
 too important to mankind at large to be hid. 
 He therefore published without exaggerating, but 
 also without minimizing, the conditions. The 
 publication came as a shock to the Glasgow 
 authorities, who gathered up their shoulders to 
 meet it. They claimed that the good results 
 in Lister's wards were really not due to Lister 
 so much as to themselves and the attention they 
 had paid to increased cleanliness, a claim that 
 was simk when Lister announced that his wards 
 alone had been excepted for three years from 
 the benefit of cleanliness. The directors were 
 particularly nettled by Lister writing from the 
 rival city of Edinburgh, and strove to throw dis- 
 credit upon the place of the writing's origin by 
 showing that in recent years their statistics for 
 amputations had been more favourable than those 
 of Edinburgh, a fact in reality due to the 
 
 1 58 
 
The Miracle 
 
 successes of the very man whose accusations they 
 were attempting to rebut. The phrase of Lister 
 that he had felt it " a questionable privilege to 
 be connected with the institution " they felt re- 
 quired a severe retort. With the ludicrous self- 
 contradiction of baffled dignity the directors 
 declared that " at all times they have been ready 
 to receive from their medical officers any sugges- 
 tions as to ht)w the hospital could be improved, 
 and these have never failed to receive their 
 immediate attention," but at the same time 
 declared that as regard's the antiseptic system, 
 the system which was to make their wards 
 immortal in the annals of surgery, they did not 
 think much of it as a suggested way of improving 
 the hospital, an opinion " which is shared by 
 those of their number belonging to the medical 
 profession." 
 
 Lister took the opportunity, in a dignified 
 answer to the Glasgow directors, once again to 
 emphasize the value of the antiseptic treatment. 
 Such an attitude was characteristic of his replies. 
 Like Darwin, he cared nothing for controversy, 
 being too deeply absorbed in his own discovery 
 and widening vista of truth to stop upon the 
 way to wrangle. The only statement of the 
 directors that angered him at all was the one 
 that implied that none of his medical colleagues 
 had any faith in antiseptics. This, he said, was 
 untrue. Mr. Macleod, his fellow-surgeon and 
 successor to the chair of Surgery, had annoimced 
 his belief in antiseptics at the meeting of the 
 
 159 
 
Lord Lister 
 
 British Medical Association at Leeds in the 
 previous year. 
 
 Though certainly of the philosophic tempera- 
 ment, Lister could not leave the dissemination 
 of his truths to the hand of time, and therefore 
 always published them whenever occasion gave 
 him opportunity to do so. His transfer to Edin- 
 burgh, however, robbed him for the time being 
 of personal opportunity. He could not imme- 
 diately get the new wards into the discipline and 
 order he desired. Nurses are not less conserva- 
 tive than other people, and as apt to think that 
 new ways are faddish, to be publicly professed if 
 the chief is strict, but privately opposed and re- 
 futed. Lister had to train his Edinburgh nurses 
 to his peculiar and troublesome ways. He had 
 to train his house-surgeons and dressers and 
 persuade them to take infinite care, when he 
 was absent as well as when he was there to 
 watch. Time also had to elapse before he had 
 had under his charge a sufficient number of illus- 
 trative cases which would once more bruit abroad 
 the value of the antiseptic system. He there- 
 fore was slowly collecting material for another 
 announcement when important and unexpected 
 testimony came from the Continent in the middle 
 of 1870. 
 
 Dr. Saxtorph, Professor of Surgery in the 
 University of Copenhagen, had paid a visit to 
 Lister at Glasgow in the previous year. He had 
 been impressed by reading Lister's reports upon 
 compound fracture. He was more impressed by 
 
 160 
 
The Miracle 
 
 what he saw. He saw wounds heal without 
 devastating inflammation. He stayed a consider- 
 able time with Lister, watching every detail of 
 the thoughtful practice. He was also a firm 
 believer in Pasteur's germ theory. 
 
 Thus equipped he returned to Copenhagen. 
 At the end of a year he, too, had wrought a 
 miracle in his surgical wards. In July, 1870, 
 he wrote to Lister the following letter : — 
 
 " My dear Sir, — It is now a year since I left 
 Glasgow, where I had the opportunity of seeing 
 how the antiseptic treatment of wounds is to 
 be carried out. Every surgeon who has seen 
 the remarkable results of this treatment must 
 feel it his duty to imitate you, and dress the 
 wounds after your principles. I therefore, as 
 soon as I came home, adopted your method, 
 and have used it now continually since that time ; 
 and I am happy to say that, although I have 
 not generally succeeded in obtaining complete 
 primary union " {i.e., healing of severed tissues 
 directly by conjunction of cut surfaces without 
 gaping), " still, the treatment has proved in other 
 respects extremely satisfactory. The hospital to 
 which I am appointed head surgeon (the 
 Frederik's Hospital) is a very old building — in 
 fact, it is now more than a hundred years old — 
 and it contains about 350 medical and surgical 
 beds. In the surgical wards I have room for 
 about I 5 o patients ; but the usual number during 
 the winter has varied from 100 to 130. Formerly 
 
 161 L 
 
Lord Lister 
 
 there used to be every year several cases of 
 death caused by hospital diseases, especially by 
 pyaemia, sometimes arising from the most 
 trivial injuries. Now, I have had the satis- 
 faction 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. But it must be clear 
 to any surgeon who has adopted your method 
 that unless you take the greatest precautions in 
 every dressing until the wound is either healed 
 or filled up with granulations, you will never see 
 the excellent effects of this treatment. It 
 certainly takes much longer time, and demands 
 much greater precautions, than any other dress- 
 ing ; but the reward is certain, and it is a satis- 
 faction to know that the good result of many 
 operations almost entirely depends upon your 
 dressing of the wound. . . . All the compound 
 fractures which I had to deal with last year, 
 some of them very severe ones, have healed 
 without the least suppuration in the fracture 
 itself, and the consolidation did not take much 
 longer time than in a simple fracture. All the 
 amputations of this year have recovered. There 
 has certainly been some suppuration, but it never 
 became profuse, and 1 never observed any putre- 
 faction. I feel so much indebted to you for 
 what I have learnt in seeing you employ the 
 antiseptic dressing that I thought it my duty 
 to let you know how things went on in my 
 hospital practice ; and I am happy to say that 
 
 162 
 
The Miracle 
 
 I have never tried any innovation which answered 
 so admirably as this treatment of wounds. 
 " Believe me, niy dear Sir, ever yours, 
 
 " Saxtorph." 
 
 This was the first really powerful testimony 
 to the antiseptic system that Lister had received, 
 and was gladly received by him, he and Pro- 
 fessor Saxtorph becoming lifelong comrades in 
 the spread of the antiseptic doctrine. Lister 
 published the letter, and added some words of 
 his own upon his initial successes in the Edin- 
 burgh Infirmary. The Edinburgh wards were 
 scarcely better than those of Glasgow. Simpson 
 had collected a dark record of i6i deaths out 
 of 371 amputations in ten years. Of amputa- 
 tions through the thigh three out of every four 
 patients died, the surgeon sowing the seeds of 
 death in the injured limb. 
 
 Lister purged his Edinburgh wards of all this 
 horrible suffering and disease as he had purged 
 his wards at Glasgow. In publishing Professor 
 Saxtorph's letter he wrote that he had intended 
 to wait for a longer time before publishing his 
 results, but " I may state that, having now been 
 in charge of fifty beds for nine months in the 
 Royal Infirmary here, I have as yet no instance 
 of pyaemia, although many cases have been 
 admitted in which it might, under ordinary treat- 
 ment, have been apprehended, such as compound 
 fractures, amputations in the lower limb, and 
 extensive gouging operations upon bone. 
 
 163 
 
Lord Lister 
 
 •Hospital gangrene has also been absent. 
 Though several cases of ulcers of long stand- 
 ing have been under treatment, there has never 
 been any appearance of greyness of the surface 
 to indicate even the mildest form of disease." 
 
 The picture of the wards had completely 
 changed. ' To men of Lister's sympathetic feeling, 
 who found the previous conditions " sickening 
 and heartrending," the new picture must have 
 been wonderfully gratifying. The air of the 
 wards was no longer burdened with a sweet 
 fcetidity, nor at the time of the dressing of the 
 wounds was it charged with a heavy stench. A 
 faint odour of carbolic mingled with the whole- 
 some air, which, blowing from the Pentland Hills, 
 bore to the patients the health of moor and 
 mountain. In place of the odour of corruption 
 and death there was the association of recovered 
 health with the plenitude of golden gorse, the 
 quivering bells of heather, and white clouds in 
 broad movement across the blue sky. Instead 
 of the wan, pinched faces, the feverish and rest- 
 less glitter of eyes searching hither and thither 
 in vain for help from agony endured, instead of 
 the skeleton hands plucking ceaselessly at the 
 quilt or tremulously fingering and feeling as if 
 for a thread of hope, instead of the gaze staring 
 blankly at the ceiling and watching hour by hour 
 for the expected vision of death, instead of the 
 groans of suffering and the prolonged and 
 piercing cries called forth by the fiery tortures 
 of gangrene, Lister in visiting his wards saw 
 
 164 
 
The Miracle 
 
 faces, often no doubt of suffering, but rarely, 
 if ever, without hope, more often radiant with 
 hope. He heard voices, no longer groaning with 
 intolerable woes, but answering his grave and 
 gentle inquiries with accents of a gratitude that 
 could scarce be uttered ; for to those who had 
 cognizance of the miracle he had wrought and 
 of which they were the first recipients he must 
 have seemed something more than human in his 
 gifts and quality. 
 
 In the midst of his great triumph Lister pre- 
 served, unstained from the breath of vanity, the 
 noble qualities of character that were his. He 
 was ever gentle, courteous, and firm. Trying 
 as are the exactions and responsibilities of an 
 important surgical post. Lister was never known 
 to speak a sharp word to house-surgeon, dresser, 
 or any one in his service. His scientific spirit 
 and discovery attracted the curiosity of the 
 students and young graduates of Edinburgh ; his 
 personal nobility won their hearts. His art of 
 winning their loyalty was by inspiring enthusiasm 
 and giving encouragement. " Often in the 
 middle of a trying operation," wrote one of his 
 pupils, " a gentle smile bestowed on us yoimg 
 students when we were honestly trying to do 
 our best as assistants was most encouraging." 
 Many of his students afterwards confessed that 
 their contact with Lister was the best and purest 
 influence of their lives. 
 
 For Lister's triumph was not a triumph of 
 intellect only or of any separate faculty of man. 
 
 i6s 
 
Lord Lister 
 
 It was one of the whole man, to which the 
 character that won reverence was as essential 
 as the victorious intellect. Had not Lister cared 
 deeply for his suffering patients he would never 
 have showed such a plenitude of power in their 
 behalf. He possessed every quality of the great- 
 ness that alone can dispense the greatest of 
 gifts to "man. He had the calm self-reliance and 
 self-consciousness of superior gifts, which are 
 founded on fact and not on false pride, and 
 which make a great man shy in that he strives to 
 conceal and not advertise his easily excelling 
 quality. From all baser elements, such as 
 petulance, hesitation, discursiveness, which 
 belong to the moment rather than the length of 
 years, he was free. He lived and worked with 
 the serenity and patience that belong to those 
 who know that their lives and work are based 
 upon the unchanging truths of nature and not 
 upon the opinions of their fellow-men. For the 
 same reason he possessed an unalterable will. 
 Gentle to those who served him and were placed 
 in his charge, he was unyielding in their defence, 
 in devices for their good, in efforts for their 
 tuition, showing the parental quality that in a 
 supreme type constitutes the powerful beneficence 
 of genius. 
 
 The sonnet of Henley the poet, who was 
 Lister's patient in the first weeks of his Edin- 
 burgh professorship, beautifully described these 
 qualities and gave a picture of Lister that no 
 other pen could attempt to equal. It was entitled 
 
 i66 
 
The Miracle 
 
 " The Chief," the name by which Lister was 
 fondly known. 
 
 " His brow spreads large and placid, and his eye 
 Is deep and bright with steady looks that still. 
 Soft lines of tranquil thought his face fulfill — 
 His face at once benign and proud and shy. 
 If envy scout, if ignorance deny 
 His faultless patience, his unyielding will, 
 Beautiful gentleness and splendid skill. 
 Innumerable gratitudes reply. 
 His wise, rare smile is sweet with certainties, 
 And seems in all his patients to compel 
 Such love and faith as failures cannot quell. 
 We hold him for another Heracles, 
 Battling with custom, prejudice, disease. 
 At once the son of Zeus with Death and Hell." 
 
 167 
 
CHAPTER VIII 
 
 THE SPREAD OF THE GOOD TIDINGS 
 
 There is a popular opinion that that which is 
 known as science has the peculiar quality of 
 endowing its devotees with an ability to resist 
 the foibles, follies, and vanities of mankind. 
 One may nowadays attack theology with con- 
 tumely and scoff at dialectical subtleties too 
 delicate for one's grasp. But science is secure 
 and impregnable. The reverence of the people 
 has confirmed it as powerfully against assault as 
 in the past they confirmed theology. It is now 
 a greater sacrilege to criticize science than to 
 criticize dogma, and science imposes upon its 
 priests a greater infallibility than theology now 
 bestows upon its priests. Subscriptions and 
 donations from the faithful pour in freely, and 
 the monastic seclusion of the laboratory replaces 
 that of the cloister. Temples to science are 
 erected throughout the land, its fanes flourish and 
 multiply, while the abbeys and churches fail. 
 And all is the result of a profound faith in an 
 abstract and impersonal thing that is held to 
 possess mysterious power for human good, 
 
 i68 
 
The Spread of the Good Tidings 
 
 namely science or the scientific method. Yet 
 nothing is more certain to the philosopher than 
 that mankind is unchangeable in its first prin- 
 cipleSj and that it is upon personality that all is 
 really based. 
 
 When theology was in the hands of powerful 
 and generous natures, then the benefits and 
 blessings which flowed from it to the mass of 
 men were unquestionable. The dogmas in their 
 profundity answered some of the strange needs 
 and passions of the profounder souls ; in their 
 more superficial reading they brought comfort 
 to countless men and women, provided they were 
 vitalized by the living presence of strong and 
 generous dispensers. In the hands of meaner 
 people the dogmas took upon themselves a 
 meaner aspect, and meaner dogmas themselves 
 came into being. It was not upon theology that 
 mankind's consolation and profit depended, but 
 upon the type of men who held power and found 
 in theology a fitting means of interpreting their 
 actions to the people and guiding them. 
 
 It is precisely the same with science. The 
 benefit that mankind derives from science is 
 dependent, not upon science itself or the scientific 
 method, but upon the greatness of the men who 
 make science the medium through which they 
 dispense their own generous power. In the 
 hands of a great man capable of getting that 
 mastery which makes a matter previously com- 
 plex and beyond man's control described by the 
 word " simple," science bestows great benefits. 
 
 169 
 
Lord Lister 
 
 In the hands of lesser men its benefits are less ; 
 they tend, indeed, to become no benefits at all, 
 but the offspring of weakness. A great accu- 
 mulation of the mediocre arises, an accumulation 
 which seems to be an inevitable part of the plan 
 of Western civilization, an accumulation which 
 would choke us with disorder and complexity, 
 the signs of mediocrity, unless some greater man 
 came and once more reduced superfluous com- 
 plexity to simplicity. For the world of the 
 West is perpetually becoming encumbered with 
 a superfluity of the commonplace and perpetually 
 in need of the selecting and simplifying power of 
 the genius. The scientific work of commonplace 
 men ought not to be regarded with gravity, as 
 if somehow science itself lifted it above the 
 commonplace and conferred upon it a peculiar 
 sanctity. A commonplace workman if left to 
 himself produces a commonplace article, and 
 it cannot be that science per se lifts similar work 
 to a higher plane. This uplifting power science 
 is certainly supposed to possess, and its posses- 
 sion is as certainly ,a delusion that has gathered 
 about science to the detriment of both scientists 
 and people. It is a belief likely to lead to as 
 black and bottomless quagmires as those to which 
 a like belief in theology led. The modern world 
 is already hampered and encumbered by a vast 
 accumulation of disordered stuff of commonplace 
 quality with a fictitious value owing to it being 
 named " science." 
 
 It is only when the relation between ordinary 
 
 170 
 
The Spread of the Good Tidings 
 
 men and the genius is one of faith on the one 
 side and parental generosity on the other thlat 
 genuine profit to mankind results. It is only 
 when the ordinary man or priest is carrying out 
 the dictates of genius— and not the methods and 
 processes agreed to by an assemfoly, who think 
 numbers constitute power— that genuine profit to 
 mankind follows. Sound tradition is always the 
 handing on from generation to generation of 
 the one-time creative, simplifying, and ordering 
 power of genius. It is the best and soundest 
 form of ancestor -worship ; and when a genius 
 makes out of confusion order and out of disaster 
 success, then so long as that tradition is faith- 
 fully preserved and followed by its priests, so 
 long does mankind continue to reap the benefits 
 of the peculiar power of genius . Lister, with the 
 whole outlook upon and minute application of 
 first principles, established and proved that that 
 which before had been unmastered was now 
 mastered. He had given a reason for his 
 success, one which will perhaps be found by 
 some future genius to require new shape and 
 interpretation, but nevertheless one which gave 
 a guidance to the ordinary man and linked up 
 his acts of treatment in a sensible whJole. 
 
 It was this : Certain germs under present 
 conditions, and especially under hospital con- 
 ditions, caused certain diseases if they got access 
 to injured tissues, Certain chemicals, amongst 
 which the best was carbolic, if applied to these 
 germs, killed or at least so altered them that they 
 
 171 
 
Lord Lister 
 
 could not cause disease. The object at which 
 to aim was never to allow any germ to get to 
 the injured tissues, whether conveyed by the 
 air, the surgeon's or dresser's fingers, the instru- 
 ments, the dressing, or from the patient's skin 
 in the neighbourhood of the wound, without it 
 first having been soaked in carbolic and rendered 
 innocuous. If, however, it did reach the wound, 
 then in the wound itself it was to be soaked with 
 a solution of carbolic or other chemical having 
 similar powers. Then when once the wound 
 was free from germs it was to be covered with a 
 protective screen or dressing of carbolic, so that 
 no germ could get to the wound without passing 
 through this screen and becoming carbolized in 
 transit . 
 
 Such was the faith that Lister had to found. 
 He had to prove it by that which always connects 
 genius with mankind, namely, practical results. 
 In other faiths it is the same. It is the practical 
 result of material benefit, sense of comfort, feel- 
 ing of things previously unintelligible becoming 
 intelligible, the consequent feeling of increase 
 of the understanding and mastery of life that 
 convince. It is, in short, the individual's share 
 in the power of genius that convinces him. It 
 is essential, therefore, for the genius to provide 
 a brief and intelligible creed and a definite ritual 
 for other men if the faith he founds is to be 
 profitable in good results to mankind. From 
 this ritual only those can deviate with safety 
 
 who have as clear a grasp of first principles 
 
 172 
 
The Spread of the Good Tidings 
 
 and their application as the founder. Such men 
 are, of course, exceedingly rare. In the matter 
 of antisepsis there were and have been none 
 approaching Lister, and his guiding work has 
 never required revision . 
 
 The first step towards the general establish- 
 ment of this ritual was auspicious. Soon after 
 Lister's publications of his results in cases of 
 compound fracture and chronic abscess, he found 
 an influential advocate in James Goodchild 
 Wakley, the youngest son of Thomas Wakley, the 
 founder of the Lancet. James Goodchild was 
 editor of the Lancet at the time when Lister was 
 promoting his doctrines. The paper had been 
 founded by his father to attack the selfish exclu- 
 siveness of the leading medical men in London, 
 who made a ring of medical information, and 
 who, through flagrant nepotism, kept all the good 
 hospital appointments in the circle of their families 
 and friends. The elder Wakley's attacks awoke 
 fierce antagonism, and Wakley himself was many 
 times called to the courts of law to answer the 
 charge of libel, cases in which the victory usually 
 laid with him'. His son James Goodchild was 
 a man of much gentler nature ; he was broad- 
 minded but non -combative. As leader of the 
 journal which his father had made the chief 
 medical paper, Wakley was important to Lister, 
 and Lister was fortunate enough to secure his 
 advocacy. But though favourable, Wakley's 
 voice was a gentle one, and its tones were not 
 far-reaching or powerfully convincing. It had 
 
 173 
 
Lord Lister 
 
 none of the thunderous quality or combative inde- 
 pendence that his father's possessed. 
 
 The elder Wakley died when Lister was 
 commencing his work. Had he lived and 
 championed antisepsis, the fame and merits of 
 the treatment would have reverberated through- 
 out the British world, and the ears of the profes- 
 sion, whether approving or disapproving, would 
 have been forced to hearken. The advocacy of 
 the son was discerning, and showed a realiza^ 
 tion of the vast possibilities of Lister's work, 
 but it lacked the force and perseverance of the 
 conviction of a strong man. In later years the 
 jealousies that existed between London and 
 Edinburgh and London and Germany, were suffi- 
 cient to turn the same advocacy into petulant 
 antagonism. 
 
 Lister published his first successes in cases of 
 compound fracture in the Lancet of 1867. These 
 successes were clearly unique, and merited a 
 leading article. Nevertheless, knowing the in- 
 capacity of men to measure the value of the 
 new, the fact that Wakley devoted a very favour- 
 able leading article to them showed that he 
 possessed a discrimination notably lacking in the 
 leading members of the profession. 
 
 " If Professor Lister's conclusions with regard 
 to the pwwer of carbolic acid in compound frac- 
 tures should be confirmed by further experiment 
 and observation, it will be difficult to overrate the 
 importance of what we may really call his dis- 
 covery." After a reference to Pasteur's work, 
 
 174 
 
The Spread of the Good Tidings 
 
 the writer continued : " It is lamentable to think 
 of the extent to which the best and most refined 
 surgery, of the time is being frustrated in our 
 great hospitals, and even in those but lately built. 
 The mortality of compound fractures, of the 
 graver amputations, of lithotomy in our larger 
 hospitals, both provincial and metropolitan, is 
 something frightful. And the occurrence of 
 death with symptoms of blood-poisoning is, un- 
 fortunately, not confined to cases of serious 
 operation, but happens ever and anon after 
 operations in themselves slight. The risk— the 
 risk of blood-poisoning— is, indeed, now the one 
 great opprobrium of surgery." 
 
 Here there was a clear recognition of the 
 curse of hospitals and the possibility of its aboli- 
 tion. One wonders that such a vision did not 
 inspire a warmer and more pertinacious 
 championship. But Wakley's recognition was 
 apparently an intellectual one, and that peculiar 
 bodily vim, or whatsoever it may be, that is 
 needed to convert a sympathy to a conviction 
 was lacking. For the space of three years the 
 personal voice of the Lancet in regard to Lister 
 was mute. 
 
 With the exception of the Lancet editorial, 
 the first notice with which the profession publicly 
 favoured Lister was a letter from a private prac- 
 titioner, reporting a single favourable case under 
 antiseptic treatment. This was a month after 
 the Lancets editorial. The next professional 
 notice quickly followed, and took the form of 
 
 ^71> 
 
Lord Lister 
 
 an anonymous letter attempting to take away 
 from Lister the merit of originality in regard 
 to the use of carbolic and to give the credit to 
 a Parisian surgeon, Dr. Lemair^. 
 
 This method of initial recognition called forth 
 a reply from Lister. To the accusation that his 
 work possessed no originality he paid little heed, 
 but he took the opportunity afforded him, not 
 for personal claims or defence but once more 
 to press the value of antisepsis and to indicate 
 the errors of faith and treatment into which 
 practitioners were likely to fall. The letter is, 
 in fact, notably illustrative of this singularity 
 of aim undeterred and undeviated by, any momen- 
 tary personal vanity, which distinguishes Lister 
 and enables one to read the power of his 
 character in the words he penned. 
 
 " I have seen Dr. Lemaire's work on Carbolic 
 Acid," he wrote, " and find that where he speaks 
 of surgical applications of that substance, the 
 principles and practice which he mentions are 
 such as sufficiently to explain the insignificance 
 of the results. I may repeat that I never claimed 
 to have been the first to use carbolic acid in 
 surgery. The success which has attended its 
 employment here depends not so much on any 
 specific virtue in it as on the wonderful powers 
 of recovery possessed by injured parts when 
 efficiently protected against the pernicious in- 
 fluence of decomposition. I selected carbolic 
 acid as the most powerful of antiseptics, but 
 
 I think it is not unlikely that my object might 
 
 176 
 
The Spread of the Good Tidings 
 
 have been gained by using, on the same prin- 
 ciple, some other ' disinfectant.' And I may 
 take this opportunity of warning some of your 
 readers that they must not expect carbolic to 
 act like a charm, but that, whether they employ 
 this agent or some other of analogous proper- 
 ties, it is only by the light of sound pathology 
 and strict attention to practical details that they 
 can hope to attain in their full measure the mag- 
 nificent results which the antiseptic treatment 
 is capable of affording." 
 
 The next professional notice of Lister's work 
 was from his great contemporary Sir James 
 Simpson. Simpson knew from bitter experience 
 how hard was the path of an innovator. His 
 great discovery of the anaesthetic powers of 
 chloroform had brought down upon him a rain 
 of attack. The clergy had been incensed with 
 a man who was presumptuous enough to take 
 away the pain that Heaven had sent to try or 
 punish mortals, and protested above all against 
 the mitigation of the pains of travail in which 
 women were doomed from the beginning to bring 
 forth children. Simpson had, however, little diffi- 
 culty in silencing them with the powerful retort 
 that, in the first operation ever recorded, God 
 caused a deep sleep to fall upon Adam. Simpson 
 was also attacked by his professional brethren, 
 if they who are oppugnant may be called 
 brethren. Simpson defended himself, not only 
 with the statistics resulting from his work, but 
 also by showing how the introducers of mercury, 
 
 177 M 
 
Lord Lister 
 
 antimony, quinine, and other benefits had suffered 
 from attack, and how the revered Jenner himself 
 had had to endure bitterness and ridicule before 
 sluggish judgments were convinced that what 
 Jenner had done could be repeated. Moreover, 
 quite recently Simpson had had to meet an 
 attempt to prove that his original method of 
 stopping haemorrhage, which he named acupres- 
 sure, was nothing but a plagiarism, little credit- 
 able to him, who had clothed an old method " in 
 all the glittering charms of novelty." 
 
 Here, then, was a man who could appreciate 
 the stony path of the bringer of glad tidings, 
 who finds himself at first ignored or slighted, 
 and then, when his discovery forces its way into 
 notice, finds people eager to prove that he has 
 been anticipated and is strutting in borrowed 
 plumes . 
 
 But, great man as Sir James was, he cannot 
 be said to rank amongst the greatest. There is 
 a definite measure to men's greatness, and they 
 may be placed first who are able to put their 
 judgment above personal considerations, because 
 they know their personal power stands above 
 that of others and cannot be surpassed. Sir 
 James felt he was being surpassed. He had 
 held a supreme position for so long that the noble 
 quality of service and loyalty to one greater than 
 he, a quality placing man next to the greatest, 
 was rendered difficult to him by circumstance 
 as well as character. It was certainly as a rival 
 he regarded Lister, whose work threatened to 
 
 178 
 
The Spread of the Good Tidings 
 
 annul his work both on hospitalism and the means 
 of stopping haemorrhage. Nevertheless, cour- 
 teous and generous rivalry is no great detraction 
 from high quality, though the highest have always 
 pursued an object without wasting their strength 
 upon personal jealousies. What, however, does 
 place Simpson upon a lower level than the 
 greatest scientists of the last century, such as 
 Darwin and Lister, is the fact that he did not 
 attack Lister upon his own ground— that is to 
 say, upon the principles, methods, and results 
 of antisepsis. 
 
 Such an attack would have been fully justified 
 if it could have been made. If Simpson had 
 repeated Lister's experiments exactly, and had 
 found them fail or dubious, then he could rightly 
 have attacked Lister. Or had he pitted results 
 obtained from some other method against Lister's 
 and kept the contest within such a ring, then, 
 again, he would have been justified. He had 
 such a method in acupressure, and he did pit his 
 acupressure against Lister's antisepsis. But he 
 did not do so until he had filled four and a half 
 columns of the Lancet with an elaborate proof 
 of what Lister had never denied— namely, that 
 other surgeons had, previous to Lister, made 
 use of carbolic acid. In short, Simpson attacked 
 Lister on the inferior level which regards the 
 personal vanity that quarrels about precedence 
 as important, and thereby proved himself the 
 inferior man. 
 
 There was, indeed, plenty of ill -concealed 
 
 179 
 
Lord Lister 
 
 jealousy in this attempted disparagement of 
 Lister, for which purpose Simpson had singled 
 himself out amongst all the members of the 
 profession. He began by quoting Professor 
 Kingston, of Montreal, who " had found the use 
 of carbolic acid was now being discontinued in 
 places where formerly it was in vogue "—a piece 
 of information which, in the light of latter-day 
 knowledge, is no great testimony to the acumen 
 of Lister's predecessors. Professor Kingston 
 sneered at Lister's treatment in so able a manner 
 that Simpson was glad to borrow it by quotation 
 to show his own feeling towards Lister : " While 
 in Great Britain he had seen it poured into and 
 over the surfaces of recent amputations and other 
 wounds, in the form' of fluid ointment or com- 
 bined with oil, in a way which recalled to his 
 mind the older and reprehensible system of dress- 
 ing with some foreign body the whole raw 
 surfaces of recent wounds— a practice that was 
 followed two or three centuries ago, and which 
 he fondly hoped was for ever banished from 
 scientific surgery." 
 
 By choosing such a quotation as a start Sir 
 James Simpson showed his jealousy of Lister 
 clearly enough. Simpson, having used Professor 
 Kingston to prove that continental surgeons were 
 giving up the use of carbolic, then set to work 
 to show that, even were there any value in 
 carbolic, at least the credit of using it belonged 
 to these surgeons and not to, the Glasgow 
 professor, whose work threatened to make 
 
 1 80 
 
The Spread of the Good Tidings 
 
 his work on hospitalism and acupressure mere 
 wastage. 
 
 The chief of these, the aforesaid Dr. L'emaire, 
 Sir James declared had bestowed great thought 
 and attention upon the use of carbolic acid, and, 
 he added politely, " in that respect, as well as 
 originality, leaving Professor Lister very far 
 behind him. On one or two points — but these 
 of a most doubtful character — Professor Lister 
 goes, perhaps, farther, for he seems actually to 
 believe that the use of carbolic acid may lea;d 
 to the absorption of a piece of necrosed bone, 
 or a silk ligature when cut short and left in a 
 wound — a kind of surgical belief in which I think 
 he will get few or no disciples to join him at 
 the present day." 
 
 There was the rub. Simpson saw that if Lister 
 could make the ligature safe his acupressure 
 invention for stopping bleeding was doomed. He 
 had spent ten years of thought and experiment 
 upon acupressure ; he had recently given it to 
 the world, and it had been hailed at the Dublin 
 meeting of the British Medical Association held 
 in the summer of 1867 with far greater enthu- 
 siasm than antisepsis. Yet Simpson saw already 
 the danger of the younger infant throttling his 
 own. He was not a man great enough to set 
 truth above feelings of personal vanity. His 
 claims in previous years of the superiority of 
 chloroform over ether as an anaesthetic greatly 
 exaggerated the advantages of the drug whose 
 powers he had discovered. A similar passion 
 
 181 
 
Lord Lister 
 
 for his own stirred him in these last years of his 
 valuable life. This parental jealousy appeared 
 clearly at the end of his article against Lister. 
 With acupressure, he declared, ligatures were no 
 longer needed. Wounds could be sewn up and 
 suppuration avoided. He quoted the good 
 results which Professor Pirrie, of Aberdeen, had 
 obtained with acupressure, a position in an article 
 of rancour not wholly pleasing to the Aberdeen 
 surgeon, for the very next week he published 
 successful cases in favour " of Professor Lister's 
 original communications on the use of carbolic 
 acid." Why, then, was Simpson's final ques- 
 tion, did not Lister introduce acupressure into 
 his Glasgow wards instead of trying to redfeem 
 the already discredited ligature by means of 
 carbolic ? 
 
 Lister, of course, had to reply to so notable 
 an opponent. His answer was admirably terse 
 and calm, in contrast to Simpson's envenomed 
 effusion. Upon the subject of Dr. Lemaire's 
 use of carbolic and his own he had already 
 written. Upon the subject of antisepsis and the 
 ligature he would again write when his new 
 material was ready. 
 
 "Sir [he wrote to the editor of the Lancet, 
 in whose paper Simpson's attack had appeared], 
 — The elaborate communication of Sir James 
 Simpson in to-day's Lancet may seem to require 
 some reply. But as I have already endeavoured 
 to place the matter in its true light without doing 
 
 182 
 
The Spread of the Good Tidings 
 
 injustice to any one, I must forbear from ajiy 
 comment on his allegations. In the forthcoming 
 numbers of your journal I have arranged to pub- 
 lish, with your permission, a series of papers 
 fully explanatory of the subject in question, and 
 your readers will then be able to judge for them- 
 selves how far the present attack admits of 
 justification. 
 
 " I am. Sir, yours, etc., 
 
 " Joseph Lister. 
 " Glasgow, Nov. 2, 1867." 
 
 Such a laconic reply scarcely permitted Sir 
 James Simpson himself again to enter the lists. 
 Another champion had to be found, and was 
 discovered in Mr. Ricketts, of Liverpool. Mr. 
 Ricketts praised acupressure and supported the 
 fiction that Lister was only reviving what others 
 had tried and abandoned. " Why give credit," 
 he wrote, " to the reintroduction of an obsolete 
 and inelegant plan, when so simple, effectual, 
 and elegant a method as acupressure obtains such 
 magnificent results ? " 
 
 A month passed and then two practitioners 
 wrote in defence of Lister, both of them declaring 
 that under their own eyes he had secured " start- 
 ling results " by his mode of using carbolic. If, 
 said they, Sir James could produce any surgeon 
 who had by means of acupressure got equal or 
 better results previous to Lister, then Simpson 
 and his surgeon, and not Lister, deserved the 
 chief credit in disposing of the problems of 
 blood-poisoning and ligature. 
 
 183 
 
Lord Lister 
 
 This, of course, Simpson could not do. His 
 attack had been ungenerous and at fault. But 
 it had one excellent result. It brought the 
 greatest surgeon of the day into the field, James 
 Syme, angrily lashing at those who tried, 
 " anonymously and otherwise, to filch away from 
 Mr. Lister the credit justly due to him for 
 devising and establishing the antiseptic system," 
 and throwing down the challenge of his seven 
 wonderful successes with the employment of the 
 antiseptic method. This, with a report of a suc- 
 cessful case by Mr. John Macclatchy and some 
 half-hearted and equivocal testimony from Mr. 
 Timothy Holmes, the editor of the famous 
 " System of Surgery," completed the strange 
 story of the first year of the reception accorded 
 by the profession to Lister's transforming work. 
 
 The next two years showed a notable neglect 
 of attention to the practice of Lister's antisepsis. 
 The attacks upon Lister's originality had failed, 
 and the interest in his results waned. A few 
 doctors from Scotland, Ireland, or the provinces 
 wrote or spoke in praise of Lister's methods, but 
 the interest was very lukewarm and provoked 
 no controversy or general discussion of the merits 
 of antisepsis. Dr. Coats, of Glasgow, called in 
 one of Lister's assistants to a severe case of 
 compound dislocation of the ankle-joint, and was 
 enamoured with the result of the treatment. Mr. 
 Tyrell, of Dublin, found carbolic of " the greatest 
 service." Mr. Hamilton, of Liverpool, empha- 
 sized the certainty of success if Lister's " defined 
 
 184 
 
The Spread of the Good Tidings 
 
 principles " were followed. Dr. King, of Hull, 
 was enthusiastic as to the value of carbolic in 
 cases of amputation. Mr. William MacCormac, 
 of Belfast, " modified " the method, but was led 
 by his success to a complete acceptance of 
 Lister's theory. Mr. Rutherford Ryley, who had 
 studied with Lister for two years before the days 
 of antisepsis and " knew him to be a philosophic 
 surgeon," wrote from Westland, the strip of 
 climbing land that separates the Pacific from the 
 wild gorges and precipices of the New Zealand 
 Alps, that in three cases of compound fracture 
 amongst adventurers exploring these inhospitable 
 regions for gold he had had " striking " success 
 with antisepsis. Mr. Wylie, another of Lister's 
 pupils, wrote from Java to say how successful 
 antisepsis had been in the tropics. Dr. Rose, of 
 Kidderminster, and Mr. Bartlett, of Birmingham, 
 reported successes with enthusiasm. But the 
 only surgeon of considerable repute to support 
 Lister was Mr. Bickersteth, of the Royal 
 Infirmary at Liverpool, who declared antisepsis 
 to be " an immense step towards the perfection 
 of our art." 
 
 The most experienced and weighty testimony 
 came from Mr. Cresswell, senior surgeon to the 
 Dowlais Iron Works in Wales. In these works 
 over 8,500 people were employed at labour not 
 infrequently punctuated with accidents. Mr. 
 Cresswell carefully studied Lister's methods and 
 applied them to his patients for a twelvemonth. 
 At the end of that time he summed up his 
 
 18s 
 
Lord Lister 
 
 experience : " The use of carbolic acid in the 
 treatment of wounds and compound fractures has 
 created quite a revolution in the surgical practice 
 of the Dowlais Iron Works ; for the last twelve 
 months I have used it extensively in the treat- 
 ment of the varied injuries that are of constant 
 occurrence, and I think I may say in every 
 instance with marked success." 
 
 This testimony called forth Mr. Wakley once 
 more to his gentle championship of Lister, he 
 being appalled by the ravages of sepsis which 
 were still unabated in the great London hospitals. 
 " Mr. Cresswell, whose surgical experience is 
 very great, says that the use of carbolic acid 
 in the treatment of wounds has revolutionized 
 surgical practice in Dowlais. And yet Mr. 
 Lister's treatment does not find much favour in 
 London. Are the conditions of suppuration 
 different here from those in Glasgow or Dowlais ? 
 Or is it that the antiseptic treatment is not tried 
 with the care without which Mr. Lister has 
 always pointed out it does not succeed? " 
 
 The record of London surgeons in these first 
 years of the unfolding of Lister's doctrine was, 
 indeed, a miserable one of jealousy and arro- 
 gance. The provinces, Ireland, and Scotland, 
 as the previous pages have shown, had come 
 forward, not in great numbers it is true, to bear 
 testimony to the human value of antisepsis. The 
 London medical world, however, possessed the 
 London characteristic of haughty indifference to 
 anything it had to accept humbly from without. 
 
 1 86 
 
The Spread of the Good Tidings 
 
 Secure in the pride of size, London then, as now, 
 only showed favour to the gifted when by their 
 service and presence they acknowledged her pre- 
 eminence and added to her hereditary grandeur. 
 It was for merit to come to London and sue 
 her favour and patronage, and not for London 
 to bend humbly in service and loyalty to merit, 
 however great it might be. The surgeons and 
 hospital staffs of the London hospitals were 
 clothed with this peculiar spirit. Until Lister 
 himself came and took up his work in London — 
 an event which will be recorded later — Londt>n 
 surgeons seemed to be barricaded against his 
 truths by an almost monstrous conceit. 
 
 In a profession whose ethics rightly demand 
 the immediate gift of any discovery made by 
 one of its members, which is likely to benefit man- 
 kind, and its probation by its leading members, 
 the duty and necessity of testing Lister's method 
 was one that could not be avoided and could 
 only be postponed by men of defective quality. 
 Only one London surgeon, however, showed him- 
 self to possess a character of generous discern- 
 ment that was not limited by a local spirit. 
 Mr. Berkeley Hill, of University College 
 Hospital, came from a family whose members 
 were as notable as those of any family in England 
 for their ability to view the public benefit with 
 eyes unclouded by personal feeling or sectarian 
 prejudice. He had himself fought a fearless 
 fight in favour of the Contagious Diseases Act, 
 and had endured much obloquy and malice in 
 
 187 
 
Lord Lister 
 
 consequence. He alone of all the surgeons of 
 London greeted Lister's discoveries in the spirit 
 in which they should have been greeted, and 
 were supposed to be greeted, according to the 
 high standard of the profession's ethics. 
 
 Mr. Hill did what was obviously the right and 
 proper thing to do. He went to Glasgow and 
 personally watched Lister's methods and results. 
 In January, 1869, seeing how little progress was 
 being made in London and how none of the 
 leading surgeons followed his example and made 
 themselves personally acquainted with Lister's 
 work, Mr. Hill declared boldly before the 
 Harveian Society that the reason why London 
 surgeons failed so totally in their trials of the 
 antiseptic system was that they had not taken 
 the trouble to find out what the antiseptic system, 
 as devised by Lister, really was. It was use- 
 less to attempt to reproduce Lister's successes 
 unless they first reproduced his principles and 
 methods. To indulge in variations before the 
 original theme had been mastered could not result 
 in anything decisive or beneficial. 
 
 The London surgeons in particular refused any 
 countenance to the germ theory of putrefaction, 
 without a belief in which Lister had said that 
 " no man can be thoroughly successful in treat- 
 ment," for " without this guiding principle many 
 parts of the treatment would be unmeaning ; and 
 the surgeon, even if he should attempt the servile 
 imitation of a practice which he did not under- 
 stand, would be constantly liable to deviate from 
 
 188 
 
The Spread of the Good Tidings 
 
 the proper course in some apparently trivial but 
 essential detail, and then, ignorant of his own 
 mistake, would attribute the bad result to im- 
 perfection of the method. For my own part, 
 I find that, in order to approach more and more 
 to uniform success, it is necessary to act ever 
 more strictly in accordance with the dictates of 
 the germ theory. Failure on the part of those 
 who doubt or disbelieve it is therefore only what 
 I should expect." ^ 
 
 Ignoring the philosophy of the antiseptic 
 system, the London surgeons could not accept 
 antisepsis as a creed and practice. They limited 
 it to a mere routine application of carbolic acid. 
 They, in fact, not only showed indifference to 
 the germ theory which Lister held to be essen- 
 tial, but they also fell into another error, which 
 Lister had foreseen — namely, looking " upon 
 carbolic in the light of a specific." This they 
 did. They accepted carbolic acid from Lister, 
 and as regards its use did the thinking for 
 themselves, and used it incidentally as a sub- 
 stitute for the water of the conventional water 
 dressing or water sponging. The result was the 
 successive failures and consequent very in- 
 different approval which provoked Mr. Wakley's 
 irony and Mr. Hill's admonition. 
 
 Mr. Wakley himself sent one of his reporters 
 to find out all about antisepsis in London. He 
 reported at the turn of the year from 1868 to 
 1869 that Lister's methods were being frequently 
 adopted " with modifications at the fancy of the 
 
 189 
 
Lord Lister 
 
 surgeon." He tried to discover the leading 
 opinions. Mr. Rouse, of St. George's, was im- 
 pressed by a case of compound fracture, in which 
 the patient unfortunately died of heart failure too 
 soon to enable the surgeon to form a definite 
 judgment. The surgeons at Middlesex Hospital 
 used carbolic, but " with a view quite different 
 from that entertained by Professor Lister." At 
 St. Bartholomew's Mr. Paget said of Mr. Lister's 
 carbolic that " in the few cases he has tried it 
 it has been useless," possibly from faulty appli- 
 cation. Mr. Coote did not approve of " Lister's 
 method, which he considers meddlesome." Mr. 
 Birkett, of Guy's, boasted the imusual experi- 
 ence that cases did " very well on the usual 
 plan," but Mr. Bryant found the results upon 
 the whole good, and this due " in a great measure 
 to the use of carbolic acid." Mr. Wood, of 
 King's College Hospital, used carbolic acid pari 
 passu with the old dressings, and his results were 
 correspondingly equivocal. Mr. Barwell, of 
 Charing Cross Hospital, used his own modifica- 
 tions with modified results, and considered the 
 methods of Lister " require much time in their 
 application," and such an experience as he had 
 had " does not encourage him to expend much 
 time on them." Mr. Maunder, of London 
 Hospital, was decidedly favourable, and reported 
 two successful cases of ligature. Mr. Holt, of 
 Westminster Hospital, was also favourable, 
 though success seemed to him a good fortune 
 rather than a certainty. 
 
 190 
 
The Spread of the Good Tidings 
 
 Mr. Wakley was gravely disappointed with this 
 mixed and indecisive record, and took the earliest 
 opportunity that occurred, in a comment upon 
 one of Lister's papers, to record his feelings. 
 " Whether surgeons," he wrote, " accept Mr. 
 Lister's conclusions or not, they must admit the 
 candour with which he reports all details of his 
 experiments, and the scientific strictness and 
 severity with which he observes phenomena. His 
 paper last week is far more than a mere con- 
 tribution to practical surgery. It enlarges our 
 idea of life and the extent to which the living 
 tissues may be made to assimilate organic sub- 
 stances. And it is a perfect model of the way 
 in which a practical art may be advanced by 
 sound minute physiological observation. . . . 
 When we compare Professor Lister's results and 
 conclusions," the writer continues in an ironical 
 vein, " in regard to the antiseptic principle, with 
 those of other surgeons, it is impossible not to 
 be struck with the difference between them and 
 him. The physiological phenomena described 
 by him are something most unusual : almost 
 entire absence of pus and of signs of inflam- 
 matory thickening, and the incorporation of 
 ligatures used with living tissues, are results very 
 different from the coarse and tedious processes 
 of old surgery. But it will be objected they 
 cannot be obtained by other surgeons. Be it 
 so. All that we can say is that they are obtained 
 by Mr. Lister." 
 
 Meanwhile how did Lister deport himself 
 
 191 
 
Lord Lister 
 
 towards this envious and feeble acceptance of 
 his great gift? We have seen in what manner 
 he answered Sir James Simpson. He followed 
 the same principle throughout. He continued 
 quietly with his work, knowing full well that it 
 was of such character as would eventually force 
 the profession to follow his dictation. Once only 
 he felt compelled to expose the bad method with 
 which Mr. James Paget had secured bad results 
 and had then announced the uselessness of the 
 method " which has been so strongly recom- 
 mended by Professor Lister." Had this 
 announcement " proceeded from any one less 
 deservedly eminent than Mr. Paget," wrote 
 Lister, " I should not have felt called upon to 
 notice it. But as anything from such an 
 authority is calculated to have great influence 
 with the profession, I have felt reluctantly com- 
 pelled to allude to this matter thus publicly." 
 He then briefly showed that Paget's method, 
 whatsoever else it was, was " certainly not in 
 accordance with the antiseptic system." 
 
 Though the London surgeons were indifferent 
 and obdurate, an opportunity came for a general 
 testimonial to Lister. The meeting of the British 
 Medical Association was held in the summer 
 holidays in 1869 at Leeds. Mr. Nunneley was 
 chosen to give the address in surgery. The lead- 
 ing members of the profession gathered to listen 
 to him. At no time did they meet in such 
 numbers ; at no time could a public record of 
 the professional attitude towards the transforming 
 
 192 
 
The Spread of the Good Tidings 
 
 work of Lister more strikingly and suitably be 
 given. 
 
 Mr. Nunneley recognized his singular oppor-- 
 tunity and delivered his testimonial with the 
 pompous clumsiness of a weak man who feels 
 strong owing to the presence of a large and 
 favourable gathering. He accused Lister of 
 stupidity. " The theory and reasoning by which 
 the antiseptic treatment of wounds is supported 
 appear to overlook facts open to all the world, 
 to disregard observations familiar to every person 
 through all ages from the earliest period to the 
 present day." The words are verbatim, and 
 though they are intended to be large and sound- 
 ing, clearly lack the bite of power. Some 
 fatal fallacy, Mr. Nunneley felt sure, lay at the 
 bottom of Pasteur's and Lister's work. " We 
 may probably with safety deny the existence 
 of germs in the number and universality main- 
 tained by Pasteur and Lister." The whole 
 theory of antisepsis was not only absurd, " it 
 is a positive injury." " During the last three 
 years," said Mr. Nunneley proudly, " since the 
 antiseptic treatment has been in vogue, I have 
 not allowed one of my patients to be treated with 
 carbolic acid." His colleagues had made use 
 of it, but were now beginning to abandon it. 
 " Its use, in fact," concluded the speaker, " has 
 become the exception and not the rule. . . . 
 I have spoken plainly on the antiseptic treat- 
 ment because I have felt decidedly." 
 
 This anathema from the very centre of repre- 
 
 193 N 
 
Lord Lister 
 
 sentative surgery loosed the tongues of bitterness . 
 Lister's antiseptic method was called " a return 
 to the dark days of surgery," though one wonders 
 when the shadow of death was deeper than at 
 that time. It was called the " carbolic mania," 
 " the latest toy of the medical profession," and 
 it was said there was even " a professional 
 criminality ... in putting forward such specious 
 doctrines as the carbolic theory." 
 
 Secure by now in his results and having his 
 cleansed wards in the Glasgow Infirmary before 
 his eyes, Lister remained unperturbed. Mr. 
 Nunneley's attack from the annual throne of 
 surgery he could not, however, wholly ignore. 
 He replied^ therefore, with the quiet irony of 
 the strong man :— 
 
 " Mr. Nunneley's recent attack " (he wrote 
 to the editor of the Lancet), " seems to me little 
 calculated to impede the progress of the anti- 
 septic treatment ; nor do I feel called upon to 
 point out in how many respects he has mis- 
 apprehended my published views. That he 
 should dogmatically oppose a treatment which 
 he so little xmderstands, and which by his own 
 admission he has never tried, is a matter of 
 small moment. But I was grieved to find him 
 stating that his colleagues who had adopted the 
 system were now abandoning it as untrustworthy. 
 It was therefore with much pleasure that I 
 received a very different accotmt of the matter 
 in a letter from Mr. Teale, in a letter which, 
 
 194 
 
The Spread of the Good Tidings , 
 
 with his permission, I now request you th 
 publish. 
 
 " I am, sir, your obedient servant, 
 
 " Joseph Lister." 
 
 Mr. Teale's letter to Lister ran as follows :— 
 
 " My dear Sir,— May I call your attention 
 to the attack upon the ' antiseptic treatment ' in 
 Mr. Nunneley's surgical address, in which he 
 quotes the experience of his colleagues as un- 
 favourable to it. 
 
 " I think it is due to yourself to inform you 
 that Mr. Nunneley was in no sense justified in 
 making such a statement ; that we still use, 
 and have as much confidence as ever in, anti- 
 septic treatment ; and we hope shortly in some 
 way or other to have Mr. Nunneley's misstate- 
 ment corrected. 
 
 " Any want of success in our practice may 
 fairly be attributed to imperfection in carrying 
 out your rules. 
 
 " Yours truly, 
 
 "T. Pridgin Teale." 
 
 The voice of the guilty conscience is often 
 unduly loud. It ^eems as if Mr. Nunneley had 
 striven hard to blind his eyes to the successes of 
 his junior colleagues with the use of a treatment 
 which he himself deliberately withheld from his 
 patients . 
 
 In the midst of this discussion, in which 
 
 195 
 
Lord Lister 
 
 human frailty displayed itself in the immaculate 
 atmosphere of dispassionate science and even 
 acknowledgment sprang from the cold sources 
 of the intellect, it is pleasing to record the per- 
 sonal relation and bond that is the mark of true 
 discipleship . 
 
 " Last August," wrote a Dublin practitioner 
 in October, 1869, " I had the pleasure of meeting 
 Mr. Lister in his wards, when I came to the fol- 
 lowing conviction : that the aspect of the patients ; 
 the appearance of the sores and wounds ; the 
 fresh, healthy atmosphere of the wards ; the 
 absence of any smell ; the quiet, impressive, 
 unobtrusive, almost retiring, manner of the pro- 
 fessor ; his labour and painstaking in explaining, 
 first his theory, and afterwards his mode of 
 application and progress through every step, and 
 their results, can only be understood or appjre- 
 ciated by a walk round that splendid institution 
 with him through his wards, and also through 
 those wards which are not under his care, and 
 where the treatment is not so accurately or not 
 at all carried out." 
 
 But the Pharisees of the south continued to 
 show indifference to the wonders that were being 
 wrought in the north, or else they continued the 
 appalling wastage that results from abstract 
 debate and controversy and was so unfortunately 
 common in those days, even though a few hours 
 in the railway train would bring a surgeon the 
 incomparable benefits of personal contact and 
 the witness of his own eyes. Mr. Wakley alone 
 
 196 
 
The Spread of the Good Tidings 
 
 seemed to be convinced of the need of the direct 
 personal element being; placed in a paTamount 
 position if the question was ever to be treated 
 with justice. " W-e have no reports of anything ' 
 like similar pains being taken in any of our 
 London hospitals," he wrote, " while we have 
 reports which show how great is the need of 
 some such agent. Let Mr. Lister's processes 
 be carefully carried out by trusted pupils of 
 his own in some London hospitals. Only some 
 such experiment as this will satisfy all parties ; 
 and in the interests of our large hospitals and of 
 humanity, the sooner such an experiment is tried _ 
 the better." 
 
 The editor of the British Medical Journal 
 joined Mr. Wakley in advocacy, and sent a 
 special reporter to the north. " Be the germ 
 theory true or false," was the conclusion, " the 
 excellent results of Mr. Lister's treatment are 
 certainly such as one does not expect to find in 
 London hospitals," 
 
 A few months later, as London had not stirred, 
 the Lancet once more broke forth in protest : 
 " The letter of Dr. Saxtorph, Professor of 
 Clinical Surgery in the University of Copenhagen 
 . . . makes it impossible that this question can 
 rest where it is. The averments on the one side 
 are so strong and remarkable, and the incredulity 
 of the English surgeons is so general that some 
 decisive steps should be made to come to a 
 scientific decision." 
 
 Nevertheless this urgent experiment in a 
 
 197 
 
Lord Lister 
 
 London hospital wa^ not carried out for another 
 seven years, ajid then the experimenter was no 
 other than Lister himself, forced to leaye his 
 friends and practice in the north by a sense of 
 the imperative necessity of overcoming the 
 obduracy of the surgeons of London. 
 
 In that time, sis will be recorded, Lister won 
 the leading surgeons of Germany and France 
 to his side, and was accorded by them and their 
 students and their friends in high positions other 
 than medical, triumphal greetings such as, as 
 a rule, only sovereigns have enjoyed. But in 
 London patients continued to suffer the agonies 
 and fatalities of all the foul and cruel forms of 
 blood-poisoning. The means to save these un- 
 fortunates were at hand. To secure them London 
 surgeons had only to put aside their conviction 
 that no good thing could come out of the smaller 
 universities of the north and humbly to follow 
 and acknowledge the great genius who was trans- 
 forming surgery from a practice that bred and 
 spread the seeds of virulent offence to one of 
 beneficence. It was, however, to be their lot 
 to share with their American brethren the dis- 
 tinction of being the last to acknowledge the 
 extraordinary powers which Lister was prepared 
 and able to place in the hands of surgeons. 
 
 Such is the record of the early spread of the 
 good tidings. 
 
 198 
 
CHAPTER IX 
 
 EDINBURGH 
 
 The send-off that the Glasgow medical men gave 
 to Lister was not brilliant. They had had the 
 greatest of surgeons in their midst for nine years 
 and for the most part failed to recognize him, 
 or had covertly or openly opposed him. His 
 successor to the Chair of Clinical Surgery, Mr. 
 Macleod, had spoken favourably at Leeds of 
 the use of carbolic, and after Lister's departure 
 continued to make use of it. But he did not 
 base his use of it upon the germ theory, but 
 held to the old faith of occlusion, which preached 
 that if air were kept from a wound all would be 
 well. With oxygen, the element of all com- 
 bustion, air had for long been held to be the 
 originator of the heat of inflammation. The 
 effects of carbolic were adapted to this theory by 
 declaring that the film of coagulum which the 
 acid formed upon the injured tissues screened 
 them from the air. Based upon this theory, it 
 was to be expected that Mr. Macleod's results 
 bore no comparison to those of Lister. 
 
 One or two practitioners in Glasgow had been 
 convinced by what they had seen in Lister's 
 
 199 
 
Lord Lister 
 
 wards, but they were the exceptions. On the 
 other hand, amongst the younger members of 
 the profession who had come under Lister's in- 
 fluence a very difi'erent effect had been pro- 
 duced. He was their chief and teacher, and 
 neither their colleague nor their rival. His pre- 
 eminence over them was, therefore, taken for 
 granted and required no generous acknowledg- 
 ment of his superior gifts. They were conse- 
 quently able to judge of Lister free from all 
 personal bias except of the favourable kind that 
 extends between students and a courteous and 
 painstaking master. There was between them 
 and Lister no fiction of equality, which tends 
 constantly to reduce any one man's pre-eminence. 
 And the result was that, as one of Lister's 
 Glasgow house-surgeons wrote : " No one ever 
 thought of absenting himself from the classroom. 
 His words, his tone of voice and quiet dignity of 
 bearing, accompanied in general with a serious 
 expression, convinced all that his heart was in 
 his work, and more than that, that our interests 
 were his interests. His students worshipped 
 him." Nevertheless the Glasgow authorities let 
 him readily slip through their fingers, and the 
 fame which brought students and graduates 
 flocking to hear him and gave a European repu- 
 tation to the medical school he served was trans- 
 ferred to Edinburgh. 
 
 The medical circle in Edinburgh to which 
 Lister was going was scarcely more friendly 
 than that which he was leaving. The Edinburgh 
 
 200 
 
Edinburgh 
 
 Medical Journal, which was its public voice, had 
 spoken very little upon Lister's work. Two 
 references alone were made to it during the 
 years in which the method of purging polluted 
 hospitals was being initiated in the sister city. 
 One of these was a brief resume of Mr. MacCor- 
 mac's account of his work in Belfast ; the other 
 was from the pen of Dr. Joseph Bell, then 
 assistant-surgeon to the Edinburgh Infirmary. 
 Bell reported a number of varied cases in which 
 he had followed Lister's method with success. 
 But he confessed himself indifferent to the germ 
 theory, and consequently though he had had 
 success with carbolic, neither at this nor at a 
 later date did he attain to a complete mastery 
 of the antiseptic treatment. 
 
 In addition to Joseph Bell in Edinburgh, there 
 was Thomas Keith, who as an operator had 
 created a record that out-distanced all others 
 by carrying out a succession of seventy 
 abdominal operations without a death. This 
 astounding success had been freely quoted by 
 Lister's Glasgow opponents in order to prove 
 how meddlesome and unnecessary the antiseptic 
 treatment was ; but they had been unexpectedly 
 countered by Mr. Keith himself, who replied 
 that in all these cases he had used some form 
 of antisepsis, and was a whole-hearted believer 
 in and follower of Lister. 
 
 Lister, of course, had a strong friend in James 
 Syme, who though partly crippled, had not been 
 deprived of his warrior spirit by his illness. But 
 
 20I 
 
Lord Lister 
 
 the world at large was inclined to attribute 
 Syjne's support more to the partiality of a father- 
 in-law than to an unprejudiced conviction as 
 to the soundness of the antiseptic system, in 
 spite of Syme's published successes and the in- 
 timate knowledge of Lister's work which he was 
 able to gain from frequent and familiar inter- 
 course. Nevertheless Syme was Lister's strong- 
 hold in Edinburgh, and without his powerful 
 advocacy it is almost certain that the Edinburgh 
 authorities would have failed to acknowledge the 
 unique claims of Lister to the professorship. 
 Nor indeed did they recognize them . The weight 
 of blood or relationship in a candidacy was well 
 recognized, and Lister's appointment was attri- 
 buted by medical men far more to Syme's than 
 to any peculiar merit of his own. "Who is 
 that?" asked an American visitor on one occa- 
 sion, impressed by Lister's appearance. "That 
 is Mr. Lister," his friend replied. " He has 
 been appointed a teacher in clinical surgery 
 through Mr. Syme's influence, whose daughter 
 he married." Wakley, it is true, through the 
 medium of the Lancet urged the appointment of 
 Lister, but the Edinburgh Medical Journal 
 devoted only two lines to the subject. 
 
 The University and medical circles of Edin- 
 burgh of that time possessed many notable men. 
 The Edinburgh scientific world was at its zenith, 
 its fame spread wheresoever the vigour and 
 movement of science was felt. As a medical 
 school, without doubt Edinburgh excelled all 
 
 202 
 
Edinburgh 
 
 other medical schools in the United Kingdom. 
 Indeed, had one gathered from the other schools 
 the most luminous of their stars, it is doubtful 
 if one could have rivalled the galaxy of the 
 Scottish capital. 
 
 The two leading men were, however, at the 
 end of their careers. James Syme, though still 
 able to do consulting work and to enter into 
 controversy with the old fire and pertinacity, 
 was in the last year of his life. His greater 
 colleague, Sir James Simpson, was dragging out 
 the last months of his profitable life imder the 
 agonies of angina pectoris, and turning some- 
 times to his own beneficent chloroform for relief. 
 
 Those who were in the active practice of their 
 profession in Edinburgh were all men of some 
 note. There was the caustic Hughes Bennett, the 
 Professor of Medicine, who had declared him- 
 self to be one of the rare medical philosophers 
 who cared for the truth and had such a con- 
 tempt for Pasteur's theory. There was James 
 Spence, the Professor of Surgery — Lister being 
 Professor of Clinical Surgery — who after Syme's 
 retirement became the leading consulting and 
 operating surgeon and who bore no goodwill 
 to the founder of antisepsis. There was Sir 
 Patrick Heron Watson, a man of great practical 
 ability ; Joseph Bell and Thomas Keith, who 
 had already acknowledged Lister ; and of the 
 younger men, Thomas Annandale, an old friend 
 of Lister's, a believer in his work and eventual 
 successor to his professorship. Other notable 
 
 203 
 
Lord Lister 
 
 men were Matthews Duncan, who already had 
 a European reputation, and succeeded Simpson 
 in the chair of midwifery ; Dr. Laycock, who, 
 Uke Lister, hailed from University College, and 
 was the only Englishman who ever occupied the 
 chair of clinical medicine in Edinburgh ; Sir 
 Robert Christison, famous for ascending the 
 slipperiness of Scotch mountains and medical 
 jurisprudence ; William Turner, the present Prin- 
 cipal and the Professor of Anatomy ; Douglas 
 Maclagan, and Dr. John Brown. The Principal 
 of the university was Sir Alexander Grant, who 
 had succeeded Sir David Brewster in 1868. 
 Together these doctors and professors constituted 
 a set of men of ability and repute, who though 
 perhaps regarding the founder of the new sur- 
 gery with some curiosity, were too fully occu- 
 pied with their own affairs to submit to a new 
 career of studentship. 
 
 But also awaiting Lister at Edinburgh was a 
 very eager and important section of medical life, 
 namely, the students and young graduates . They 
 anticipated Lister with no little excitement, for 
 his fame had been bruited from their Glasgow 
 contemporaries. With the eyes of youth, that 
 custom had not staled, and with ears receptive 
 to the doctrine that was likely to bring them most 
 success in life, they were, though pupils, in reality 
 the judges of the contest that had already begun 
 and was now to be waged in their midst between 
 the selected chiefs whom they served. To which 
 camp were they to belong ? To the camp of the 
 
 204 
 
Edinburgh 
 
 majority and orthodox, or to the professor about 
 whom such strange rumours emanated from 
 Glasgow ? Were they to adhere to the old chiefs 
 or were they to flock to the standard of the new 
 leader? A stir of battle was in the air and 
 rendered the charged atmosphere of student times 
 more strained and excitatory than at any other 
 time in medical history. 
 
 " From the beginning I had youth on my 
 side," said Lister in later years. His success 
 with the students and young graduates of Edin- 
 burgh was phenomenal. It began with the 
 first lecture that he was called upon to deliver. 
 The lecture was given in the old chemistry class- 
 room. Sir Alexander Grant was in the chair, 
 and many notable men were present, most of 
 them sceptical, all curious, and some, one thinks, 
 feeling a little dread, for the possibility of being 
 forced to change one's faith and habit funda- 
 mentally is rarely an agreeable one. Above 
 all, there were the younger men, who filled the 
 room to overflowing. Old James Syme entered, 
 and the tension of the meeting, which was already 
 great, broke out into a stormy ovation as the 
 familiar figure of the beloved teacher appeared 
 once more in the midst of his students. 
 
 Lister was then forty-two years of age. His 
 appearance at once impressed those who saw 
 him for the first time with the feeling that they 
 were in the presence of a great man. He was 
 a little above the medium height, was slender 
 and excellently proportioned. He carried him- 
 
 205 
 
Lord Lister 
 
 self with a singular grace, and every movement 
 was fraught with the ease and control that are 
 the qualities of dignity. His face was one that, 
 without disparagement to his manhood, could 
 be called beautiful. It had the high thought- 
 fulness, the unlined nobility, the evident detach- 
 ment from momentary matters and absorption 
 in matters that are rooted in the eternal truth, 
 which gave to Lister's more, I think, than to any 
 other English face the wonderful meditative 
 serenity and power that forms the exalted aim 
 of Oriental wisdom. His hair was dark and 
 luxuriant, his complexion one of such clarity 
 as indicated a blood of the purest quality and one 
 untainted by the confused thought and incer- 
 titude which with the great mass of men connect 
 their imperfect humours with the lined and 
 anxious expression of their faces and the vexed 
 light within their eyes. 
 
 Lister was an admirable teacher, his language 
 clothing his thought with luminous simplicity. 
 His voice was not loud, but carried easily to 
 the limits of a lecture-hall. The words he 
 desired came to him readily, and he never had 
 to hesitate for the expression that was most 
 fitting. He had a slight difficulty in pronouncing 
 certain consonants, which, without impairing the 
 audibility of his words, gave them a certain dis- 
 tinguishing personality and had a charm for his 
 hearers, perhaps in that it robbed them of any 
 provocative assertion which might easily have 
 attached itself to so transcendent a message. He 
 
 206 
 
Edinburgh 
 
 was, as a fact, both as teacher and preacher of 
 a new doctrine, absolutely free from self-assertion 
 and affectation, and his full but gentle voice, with 
 its slight hesitation, seemed singularly in keep- 
 ing with his impressive but retiring manner. 
 However much his doctrine aroused animosity, 
 in his personal presence none were ever able 
 to maintain hostility and usually passed under 
 the spell by which he swiftly won the sympathy 
 of others. He always spoke earnestly and 
 gravely. He was free from solemnity and— 
 perhaps some will think this a defect — he was 
 also free from humour. But there was some- 
 thing about his mission and his gospel that I 
 cannot but think would have accorded ill with 
 humour. His gentle gravity and earnestness 
 were more fitting to a message that announced 
 the salvation from pain and death of countless 
 human sufferers, and which required neither the 
 excuse nor adornment of humour. 
 
 On the occasion of this opening lecture 
 at Edinburgh, Lister was graver and more earnest 
 than his wont. He showed a heightened colour, 
 and his curious difficulty with certain consonants 
 was more pronounced than usual. But from first 
 to last his delivery was easy, his mastery of his 
 subject absolute. He spoke extempore, and only 
 referred to his notes when the exact nature or 
 the figures of his results had to be recorded. 
 
 Lister began his lecture with a personal tribute 
 to James Syme, whom he named as a teacher 
 without rival and whom he gracefully assured 
 
 207 
 
Lord Lister 
 
 the students they would not wholly lose, for " as 
 I have the privilege of free access to his inex- 
 haustible store of wisdom and experience, he will, 
 in some sense, through me be still your teacher." 
 
 He then entered into his peculiar field, in 
 which he claimed the character of surgery had 
 changed. " Surgery becomes something totally 
 different from what it used to be ; and injuries 
 and diseases formerly regarded as most formid- 
 able, or even hopeless, advance quietly and surely 
 to recovery. Of this system the germ theory 
 of putrefaction is the pole-star which will guide 
 you to safety through what otherwise would be 
 a navigation of hopeless difficulty." 
 
 Lister continued with the history of the germ 
 theory, and spoke of work of which during the 
 period of his earlier experiments he had been 
 ignorant but to which his attention had since 
 been drawn. He spoke of Cagniard-Latour and 
 Schwann, the truth of whose researches had been 
 popularly obliterated by the combined weight of 
 Leibnitz and Helmholtz. "It is true," he said 
 of Schwann's experiments, " that if you attempt 
 to repeat the experiments you may meet with 
 failure. But it must be remembered that merely 
 negative results go for nothing here if the posi- 
 tive evidence rests on satisfactory authority. 
 ... If we consider what the germ theory 
 assumes, how minute the putrefaction particles 
 are supposed to be, and how universally present 
 in the atmosphere and in the dust which adheres 
 to all objects exposed to it, it is easy to under- 
 
 208 
 
Edinburgh 
 
 stand failure in such experiments consistently 
 with the truth of the theory. But it is impossible 
 to understand success in any single instance 
 consistently with the falsehood of the theory." 
 For instance, Schwann had kept meat-juice in 
 flasks, which had first been heated, and had 
 allowed air to enter the flasks only after it had 
 been passed through the flame. The meat-juice 
 remained pure indefinitely. This was a positive 
 result effected by a great scientific authority. 
 Meat-juice exposed to the ordinary air invariably 
 goes bad. But by flaming the air all living 
 germs were burnt. One genuine experiment out 
 of a thousand failures, said Lister, was enough 
 to prove that it was not the oxygen which caused 
 putrefaction, but something which the heat 
 destroyed. 
 
 Lister went on to describe the process of 
 fermentation of beer which is analogous to the 
 process of putrefaction. In the fermentation of 
 beer the growing and budding yeast may readily 
 be seen. " You can see with the microscope 
 the torula of fermenting must or beer. Is there, 
 you may ask, any organism to be detected in 
 putrefying pus? Yes, gentlemen, there is. If 
 any drop of the putrid matter is examined with 
 a good glass, it is found to be teeming with 
 myriads of minute bodies." 
 
 Were these tiny creatures spontaneously 
 created in the fluid, or had they parents? 
 Lister related his earliest experience with the 
 vexed question, which Pasteur finally settled. As 
 
 209 o 
 
Lord Lister 
 
 a boy an elderly friend had informed him that 
 cheese mites were spontaneously generated in 
 cheese. With his microscope Lister had ex- 
 amined the cheese and found the eggs of the 
 mite. From that time his doubt of the doctrine 
 of spontaneous generation had begun. 
 
 Lister had from the first freely and continu- 
 ously acknowledged his indebtedness to Pasteur. 
 He now gave an account of the experiments of 
 the great Frenchman, which have already been 
 described in Chapter IV^ Pasteur's " beautiful 
 researches," as Lister called them. One of these 
 experiments, one that " charms us alike by its 
 simplicity and perfect conclusiveness," Lister had 
 repeated, and now showed the results of it to his 
 audience. 
 
 He had taken four flasks and filled each one 
 a third full with putrescible fluid. He had then 
 heated the necks of three of the flasks and drawn 
 them out into long, low-dipping tubes, forming 
 the simple type of flasks originally used by 
 Pasteur. He had boiled the fluid in all four 
 flasks for five minutes to kill the germs. He 
 had then set aside the flasks with the mouths 
 of their necks open to the air. In the fourth 
 flask the fluid became thick and foul. The fluid 
 in the other three flasks, on the other hand, had 
 remained quite sweet for a space of two years, 
 and was still sweet and clear when Lister showed 
 two of the flasks to his audience. 
 
 What was the explanation? Air had entered 
 and could enter freely into the flasks, for the 
 
 210 
 
Edinburgh 
 
 mouths of all of them were unstopped. But 
 in the case of the flasks with the bent necks 
 the air had had to pass up the long-drawn necks, 
 and in passing up its dust by its own weight had 
 become deposited in the neck before reaching 
 the fluid. In the fourth flask the dust of the 
 air had fallen unhindered into the fluid. 
 
 Lister told his audience that a few days before 
 he had broken the neck of one of the three un- 
 tainted flasks and had examined the fluid in it 
 with the microscope. He had been unable to 
 detect any signs of germs or organisms. He 
 had then set aside some of the fluid that had 
 remained pure for two years, placing it in an 
 uncovered watch-glass. In two days its colour 
 had become darker, it had swarmed with minute 
 life, and had begun to smell. In a word, it 
 had begun to putrefy. 
 
 Such experiments were convincing enough. 
 They pointed unmistakably to the dust of the 
 atmosphere, that coats all things, as the cause 
 of putrefaction and to the germs, which formed 
 the living part of the dust, as the special cause. 
 Lister, did not, however, state this obvious de- 
 duction in BO many words. He left it to the 
 thought and judgment of his hearers, knowing 
 full well that if they themselves contributed it 
 the force of his facts would be more deeply 
 implanted in their minds than if he did the whole 
 work for them. " Gentlemen, I commend these 
 facts to your gandid and impartial judgment," 
 were the concluding words he addressed to the 
 
 211 
 
Lord Lister 
 
 students, " beseeching you to form your own 
 opinions regarding them. The minds which you 
 bring to bear upon this subject to-day are very 
 much the same as they will be throughout your 
 lives. . . . You are as competent as you ever 
 will be to draw logical inferences from estab- 
 lished data. Do not, then, let any authority 
 shake your confidence in knowledge so obtained." 
 
 It will be noticed as singular that in this first 
 and most important lecture Lister made no refer- 
 ence to his surgical successes. Philosophically 
 he desired first to implant first principles and 
 then to establish results. If once the theory 
 was firmly grasped by the students, he would 
 be content, knowing full well that his words 
 would soon be fulfilled by practical successes. 
 In these early days at Edinburgh he was pecu- 
 liarly insistent upon the truth of the germ 
 theory. 
 
 He had a particular reason for being so. Next 
 to Syme and Simpson, the most prominent figure 
 in the Edinburgh medical faculty was Dr. 
 Hughes Bennett, the Professor of Medicine. 
 Bennett was an acute, caustic man, with a con- 
 siderable gift of critical scepticism, which made 
 him more feared than loved by his colleagues. 
 He had been a militant advocate of the micro- 
 scope, and considered the neglect of its use to 
 be a signal proof of the imbecility of his pro- 
 fessional brethren. The microscope was con- 
 sequently in more or less general use when Lister 
 came to Edinburgh; and Bennett had come to 
 
 212 
 
Edinburgh 
 
 regard himself as a censor of the results which 
 others obtained by means of his favourite 
 instrument. 
 
 Bennett's experience in things microscopic 
 was therefore unquestioned, and the new theory 
 that microbes and the spores of fungi existed 
 in the dust of the air met at once with his censor- 
 ship. He collected the evidence of varied 
 observers, who had not observed the microbes 
 in dust, though they had endeavoured to do so. 
 "Where are the germs, then?" cried Dr. 
 Bennett. " Show them to us and we will 
 believe . Has anybody seen these germs ? Had 
 they any existence except in the imagination?" 
 And again : " The dust has been ransacked for 
 these organic germs — collected and carefully ex- 
 amined with the microscope, near the soil, and 
 on the summits of the highest buildings, not 
 only in frequented but in desert places ; in 
 crowded assemblies as well as in empty Gothic 
 cathedrals and ancient vaults — in the ancient 
 palace of Karnak, on the banks of the Nile ; 
 in the tomb of Rameses II at the extremity of 
 the desert, as well as in the central chambers 
 of the great pyramid of Gizeh." Nevertheless, 
 nowhere could the zealous microscopist detect 
 germs, or, Dr. Bennett admitted, " if a few, in 
 the opinion of some, were visible," could these 
 in any way account for the multitude found in 
 putrefying fluids? 
 
 Disbelieving that the scattered germs in the 
 dust could multiply to such numbers when they 
 
 213 
 
Lord Lister 
 
 had access to putrescible matter, Dr. Bennett 
 set out to show the absurdity of the whole germ 
 theory. 
 
 It is an axiom of science that the experiment 
 of one observer can be repeated by another, an 
 axiom which by leaving out the personal element 
 occasionally leads to the queerest results. The 
 performer by this axiom is clearly of no import- 
 ance ; it is the method alone that matters. Yet 
 in very delicate scientific operations and experi- 
 ments, as in the refinements of artistic work, it 
 is the peculiar excellence of the experimenter 
 that tells, and it is the one thing that cannot be 
 exactly repeated by another experimenter. Where 
 a method is coarse or where it can be so stereo- 
 typed that an average man may be trained into 
 an exact imitation of the original worker, there the 
 repetition of the experiment and its results may 
 be assured. But where the experiment requires 
 a rare and refined skill, there repetition is far 
 less likely to succeed. This axiom of science, 
 then, requires that scientific knowledge or work 
 be kept, if I may use a term from high jumping, 
 below the six-foot bar. The highest refinements 
 of human technique or thought do not come 
 within the scope of science, since they are 
 personal and not repetitive. 
 
 Pasteur's experiments, being scientific, were 
 theoretically below the six-foot bar. Dr. Bennett 
 was a well -trained man — in fact, for experience 
 in experimenting there was scarcely a better 
 trained man in Scotland. He was certainly up 
 
 214 
 
Edinburgh 
 
 to any jump below the six-foot bar. But the 
 rare and unsurpassed accuracy, the refined self- 
 criticism, and lucid deduction of Pasteur were 
 not his. Dr. Bennett consequently succeeded 
 in repeating Pasteur's experiments but not his 
 results. Nor did he stand alone in this. In 
 France expert scientists, such as MM. Jolly and 
 Musset, had also repeated Pasteur's experiments, 
 but not his results. Both they and Dr. Bennett, 
 therefore, measuring Pasteur upon the scale of 
 themselves, concluded that the French savant 
 was wrong. The germ theory was fallacious. 
 The germs were " imaginary." Sir James 
 Simpson, hearing of Dr. Bennett's work, 
 christened them with the happy term of 
 " mythical fungi." 
 
 It was not unnatural, therefore, that Lister 
 felt the importance of insisting upon the truth 
 of the germ theory to the students, amongst 
 whom the name of Dr. Bennett was one of 
 unequalled authority. 
 
 Before coming to Edinburgh Lister had re- 
 peated one of Pasteur's simplest experiments, and 
 had shown the results at his first lecture. He 
 now felt the necessity of planting himself more 
 firmly upon the germ theory than was attained 
 by a highly justifiable personal belief in Pasteur. 
 He had to prove its truth to himself and to 
 others by his own experiments. Lister was a 
 man of indefatigable industry when he had a 
 purpose in view. In spite of his operative and 
 overseeing work in the hospital, in spite of the 
 
 215 
 
Lord Lister 
 
 work connected with his private practice, in spite 
 of his classes and the time absorbed by reading 
 the up-to-date surgical and medical literature, 
 Lister, chiefly by early rising and putting in one 
 or two hours of work before breakfast, managed 
 to devote an enormous amount of labour to 
 strengthening the foundations of the antiseptic 
 treatment. His notes display his zeal. They 
 most of them record observations taken between 
 7 a.m. and lo a.m., but others are timed at 
 midnight, others, again, in the raw hours of the 
 morning between 3 and 4 a.m. 
 
 One of Lister's experiments was delightfully 
 simple and convincing, and contains within it 
 the principles of the best modern dairying. 
 Lister took some wineglasses and heated them 
 by means of a spirit-lamp. He also heated some 
 cover-glasses for them. The covered wineglasses 
 he took to a dairy. Under his instructions a 
 milkman purified his hands in a solution of 
 carbolic acid. The teats and udder of the cow 
 were similarly purified. The cow was then 
 milked into the wineglasses and the glasses 
 quickly covered, taken home, and set aside. 
 Eighteen months later Lister took the glasses 
 to a meeting of the Royal Society of Edinburgh. 
 In the presence of the members he uncovered a 
 glass and sipped the aged milk. It was still 
 sweet and pure. He handed it to Tait, the Pro- 
 fessor of Physics. Tait also tasted it and agreed 
 to its quality. Other glasses were uncovered 
 and handed to the learned fellows to taste. 
 
 216 
 
Edinburgh 
 
 One after another drank at the tiny wells of truth 
 and wondered. 
 
 It is improbable, however, that any of them 
 made Lister's further important deduction. 
 
 Milk when exposed to the air_, of course, turns 
 sour, and mucus when exposed also goes bad. 
 But the milk and mucus that lie in the ducts 
 which conduct the milk from the cow's udder to 
 the outside world do not go bad. The deduc- 
 tion that Lister made was that the living 
 mucous membrane of the milk-ducts somehow 
 prevented the development of the germs of putre- 
 faction. Lister gained thereby an added con- 
 ception of " vitality " in action, the vitality whose 
 paralysis by irritants had formed the earliest of 
 his particular views of Nature unveiled. The 
 point shows how keen was his vision for all 
 evidence bearing upon the quality of vitality and 
 illuminates the direct continuity and wholeness 
 of genius. 
 
 The apparatus which Pasteur had used in his 
 experiments had been singularly simple. The 
 fluid he had used was one calculated to test 
 the nature of fermentation in which he was 
 chiefly interested. It consisted of an artificially 
 prepared solution of lump -sugar, tartrate of soda, 
 and the ash of yeast. The fluid was rendered 
 germ free by boiling. 
 
 Lister, on the other hand, was concerned with 
 the question of the putrefaction of the fluids and 
 juices of the body. He worked, therefore, chiefly 
 with milk and fluid from the bladder. His 
 
 217 
 
Lord Lister 
 
 methods also were extremely simj>le. He used 
 covered wineglasses and a glass pipette. 
 
 As a contrast to the simple methods of these 
 two men of genius, one may take the work of a 
 man of talent and training such as Dr. Bennett. 
 His apparatus and method displayed the com- 
 plications and cumbersomeness that debar a man 
 from solving profound problems when he lacks 
 the selective simplicity of genius. Dr. Bennett 
 made use of various boiled and prepared fluids, 
 a ball-bellows, a U-tube containing potash, a 
 hollow glass sphere containing gim-cotton, a 
 Liebig's tube filled with pumice-stone, a bent 
 tube containing pumice-stone soaked in sulphuric 
 acid, a large basin, and, lastly, the flask contain- 
 ing the original fluid to be tested, fittingly placed 
 upside down. 
 
 Such an apparatus introduced a number of 
 modifying factors and an equal number of sources 
 of contamination. One is scarcely surprised, 
 then, that Dr. Bennett, aiming at results by such 
 mazy means, found so much diversity of issue 
 that he rapidly acquired the character of a 
 sceptic. The fluids he tested, though originally 
 free from germs and spores, as a rule soon 
 became a microscopical menagerie of yeasts, 
 spores, fungi, bacteria, and vibrios, budding, 
 elongating, sprouting, dividing, wriggling, 
 diving, quivering with Bruonian motion, which 
 so confused the learned professor that he could 
 come to no other conclusion than that they had 
 all arisen de novo, and that one form gave rise 
 
 218 
 
Edinburgh 
 
 to another, granules to ovules, ovules to rods, 
 rods to filaments, and so on. What other ex- 
 planation could there be, seeing that he had taken 
 every precaution to keep his apparatus free from 
 accidental contamination? That complexity, and 
 redimdancy are the signs of lesser gifts, to which 
 it is seldom or never granted to unravel the 
 secrets of Nature, could scarcely appeal to him 
 as an explanation. 
 
 Lister, on his part, caused animal fluids, either 
 of the bladder or udder, to be passed cleanly into 
 glasses which had been rendered germ-free, or, 
 in technical language, sterilized by heat, and 
 which were immediately covered by cover-glasses 
 similarly sterilized. Under these conditions 
 Lister found that the fluids remained pure for 
 an indefinite period. He also found that the 
 white of an egg, taken from an egg the shell of 
 which had been carefully cleansed and dropped 
 into water that had been boiled, also made an 
 animal fluid that remained pure indefinitely in 
 a sterilized covered glass. Thus at one stroke 
 Lister answered those objectors who said that 
 the boiling of the fluids or heating of the air so 
 altered matters that the proper conditions for 
 spontaneous generation were upset. He proved 
 convincingly that animal fluids, even outside the 
 body, had no inherent tendency to putrefy, and 
 therefore that putrefaction was due to something 
 in the air and in the dust, or to matter adherent 
 to the sides of the glass, which the heat 
 destroyed. Further, since the distinction between 
 
 219 
 
Lord Lister 
 
 putrefying and non -putrefying fluids lay chiefly 
 in the fact that the first swarmed with micro- 
 scopic Ufe and the second was free, the deduction 
 that what the heat destroyed was the microscopic 
 Ufe was a fair and even obvious one. 
 
 The experiments which Lister conducted not 
 only displayed his selective simplicity— they also 
 showed his pertinacity. For no less than two 
 years he watched the life history of a single 
 fungus, which he named the Torula ovalis, both 
 in animal fluids and in Pasteur's solution. He 
 saw what it did, what shapes it took, how it 
 flourished, how it waned, and yet how through 
 all these changes from youth to age, from starva- 
 tion to fattening diets, it retained, as a human 
 being retains, its peculiar character. This, as 
 he himself said, was " a fact fraught with the 
 deepest instruction." It went to show the specific 
 character of even the minutest form of life, a 
 character contradicting the generally held belief 
 that, as Dr. Bennett saw; low forms of life pass 
 readily the one into the other. Life, Lister saw, 
 was something definite even in these low forms. 
 The less definite vision of Dr. Bennett and many 
 others saw microscopic life as one might watch 
 from a balloon a street scene of moving men, 
 women, children, dogs, horses, and traffic, unable 
 in the medley to distinguish the specific character 
 of each moving thing. 
 
 Lister confirmed these observations upon 
 another organism— which he named Oidium 
 toruloides— which he kept in a most ingenious 
 
 220 
 
Edinburgh 
 
 contrivance of his own that he named a " glass 
 garden." These gardens rendered excellent 
 results in his hands, but, like Pasteur's flasks 
 on the Mer de Glace^ " require considerable deli- 
 cacy and quickness of manipulation." " With 
 them," he said, " I have watched one of the 
 same organism continuing to grow unmixed in 
 such a garden for several weeks together, though 
 carried about with me on a journey made in an 
 autumn holida,y." 
 
 Lister proved the specific character of fungi, 
 a proof which in mfedical language has now 
 passed into the term " specific organism." In 
 animal fluids, by a simplicity and skill equal to 
 Pasteur's own, he confirmed the French savant's 
 theory and did away once and for all with the 
 oxygen theory of putrefaction. 
 
 He pointed out also the many errors into which 
 observers could fall, and gently declared that 
 " without the slightest doubt being thrown upon 
 the good faith of the observers, the so-called 
 facts are justly received with the gravest sus- 
 picion." Indeed, in some work he himself did 
 upon the bacterium lactis, the common microbe 
 of sour milk, he himself unsuspectingly fell into 
 error owing to his fluids becoming contaminated, 
 and drew deductions which later he had to with- 
 draw, saying that " next to the promulgation of 
 new truth, the best thing, I conceive, that a 
 man can do is the recantation of public 
 error." 
 
 On the positive side Lister made other dis- 
 
 221 
 
Lord Lister 
 
 cover ies, which later became of first-rate im- 
 portance in the unraveUing of the mystery of 
 disease. He indicated why it was that disease 
 organisms were sometimes more virulent than 
 at other times and the lines of further research, 
 elucidating " points of great importance in the 
 history of contagious diseases, such as the greater 
 virulence of such disorders at some periods than 
 others." He showed how putrefaction and blood- 
 poisoning could occur, although the tissues of 
 the wound had no odour, " a fact I have long 
 suspected, as a result of antiseptic surgery," and 
 one of primary, importance in the elucidation of 
 certain mysterious cases. He also showed that 
 " various as are the organisms which float in the 
 atmosphere, they constitute a very small pro- 
 portion of the abounding particles of dust which 
 a beam of sunlight reveals in an occupied 
 chamber," and that " organic germs are not 
 nearly so abundant in the atmosphere as is some- 
 times assumed," facts which eventually led to 
 the discovery that the infection of wounds from 
 the air, though it occurs, is quite unimportant 
 compared to the infection from the hands and 
 instruments of the surgeon, dresser, or nurse, or 
 from the skin of the patient. Such were the 
 important principles and discoveries that Lister 
 gathered from his experiments. The small glass 
 garden was fertile as none other before or after 
 it with a crop of human benefit. 
 
 Lister, while at Edinburgh, carried out a good 
 deal mor^ bacteriological work, the greater part 
 
 222 
 
Edinburgh 
 
 of which he never published^ but to which he 
 occasionally referred in his lectures. By it he 
 tested any new antiseptic method or dressing 
 he thought to employ ; he strengthened his know- 
 ledge of the ways of infection, he foretold the 
 true nature of erysipelas, he prophesied that of 
 lockjaw, and generally cast his mind into the 
 future with a brilliancy that, though the science 
 of bacteriology was only in its infancy, showed 
 such an insight that one may say there is no prin- 
 ciple of importance in the expanded science which 
 Lister did not gather from his experiments, con- 
 ducted in the early morning hours when most 
 men slept in bed. 
 
 A man of such energy and devotion as Lister 
 was was bound to affect many enthusiastic youths 
 to whom zeal is contagious. But when the same 
 energy and devotion are combined with wonder- 
 ful practical results even sluggish youths are 
 stirred to note. Lister's successes in the usual 
 operations continued, and, armed with the 
 assurance of antisepsis, he devised, dared, and 
 executed many new operations. His work in 
 the field of operative surgery was as original 
 and successful as elsewhere, and quite a number 
 of new treatments were established by him at 
 this time. With such a generating power of 
 genius in their midst, it is not astonishing that the 
 students took fire . An able series of students and 
 graduates served Lister in the capacities of 
 house-surgeon and dresser, for he acted as a 
 mag!net to all the most capable youths, and 
 
 223 
 
Lord Lister 
 
 like a maghet imparted some of his quality to 
 them. 
 
 His lectures and clinical classes were crow'ded. 
 Three to four hundred students would throng to 
 a lecture. Such, indeed, was the enthusiasm that 
 when the University classes broke up at midday 
 the students would race to the infirmary in order 
 to get seats at Lister's lecture. They knew that 
 they would hear something original and valuable, 
 something not in any of their textbooks, and 
 they listened eagerly ; for Lister, with his imme- 
 diate vision of nature and disease, taught as one 
 with authority. There were, however, some 
 students who, serving other surgeons, felt called 
 upon to oppose him and his followers, but it is 
 stated authoritatively that when such a student 
 fell ill and needed an operation it was to Lister 
 and not to the other surgeons that he applied. 
 " Those crowded hours of glorious work in Edin- 
 burgh," as one of Lister's house-surgeons called 
 them, were days of ever-growing efficiency and 
 success. James Syme, whilst yet able, took his 
 own pride in it, and sometimes accompanied 
 his son-in-law upon his hospital rounds. On 
 one occasion Lister showed him a compound dis- 
 location and fracture of the ankle-joint healing 
 quietly under the new treatment. Syme turned 
 to the patient. "You are fortunate, my man," 
 said he. "I lost several such cases as yours in 
 this very ward." On another occasion an elderly 
 man who had had his foot amputated by the 
 father-in-law returned to have another amputa- 
 
 224 
 
Edinburgh 
 
 tion higher up the limb performed upon him 
 by the son-in-law. In a fewi days the man was 
 so well that he was sitting up reading a news- 
 paper. The house-surgeon asked him how he 
 felt. "Oh, fine!" he replied; then, looking 
 round the clean and healthy ward, he added, 
 " Eh, man, but you have made grand improve- 
 ments since I was last here." Lister, on being 
 told the story, was greatly pleased, and said to 
 the patient in the course of his visit, " So ypu 
 think we have m'ade great improvements since 
 you were last here ? " The man replied heartily 
 in the affirmative. Lister smiled the " rare, sweet 
 smile " that sometimes broke upon his accus- 
 tomed gravity, but made no comment. 
 
 In addition to winning over the students. Lister 
 began to gain the adherence of many foreign 
 medical men, who came to visit Edinburgh either 
 owing to the University's general repute or ex- 
 pressly to see Lister's work. Professor Saxtorph, 
 whose powerful evidence of the cleansing of 
 Frederik's Hospital, in Copenhagen, has been 
 recorded, was an annual visitor. Dr. Lucas 
 Champonniere, as a medical student, had visited 
 Lister in Glasgow and continued to follow his 
 work Avith great care. German and Danish 
 surgeons in especial came to study Lister's 
 methods, and to compare what they saw in the 
 wards of his colleagues at the infirmary. Again 
 and again Lister entered intO; an explana;- 
 tion of his principles and the minutiae of 
 his dressings, speaking in French or German 
 
 225 p 
 
Lord Lister 
 
 if there was need. He then sht>wed his visitors 
 his results. 
 
 Lister, his wife, and frequently her sister, 
 Siyme's younger daughter, lived in Charlotte 
 Square, the square inhabited by the leadingi pro- 
 fessional men of Edinburgh. They lived very 
 quietly, rarely going out into society and devoting 
 their time to the furtherance of the antiseptic 
 system. Here Lister entertained his visitors, 
 showed them laboratory experiments, hospital 
 records, and everything: that would help them 
 to comprehend his method. 
 
 But " his own countrymen," wrote Dr. Grasset, 
 one of his house-surgeons, " and those on the 
 staff of his own hospital were infrequent visitors." 
 Two surgeons to the infirmary were_, however, 
 thorough believers in antiseptic surgery— namely, 
 Mr. Annandale and Mr. Joseph Bell— and prac- 
 tised it with success, though not with the success 
 of Lister, finding the new principles difficult to 
 grasp in their entirety. A younger man, John 
 Chiene, the present Professor of Surgery at Edin- 
 burgh, was a wholehearted disciple, and so 
 mastered the method that, on his being elected 
 assistant -surgeon. Lister gave him a large share 
 of the practical work in his wards, and when he 
 himself was awajy left him in charge without 
 any fear that the patients would suffer by his 
 absence . 
 
 The neglect on the part of his colleagues and 
 countrymen hurt Lister, and caused him to feel 
 very sad at the thought of the great suffering 
 
 226 
 
Edinburgh 
 
 that might be allayed. And, strangely enough, 
 this neglect led to one of the very few good 
 stories that are attached to this m!an who in public 
 preserved so grave a demeanour. He had occa- 
 sion to operate upon a woman for cancer. Under 
 strict antisepsis the wound healed painlessly and 
 progl-essively. In showing it to his class, Lister 
 thought with a sigh of the many sufferers who 
 were kept from the bounty his patient had 
 enjoyed, and said, " What would not be said of 
 antisepsis if only this woman had been a princess 
 of the realm ! " An enterprising American 
 surgeon who Was listening was ready with a 
 singular reply. " Say, Mr. Lister," he said, 
 " what a pity it is you do not practise surgery in 
 America, where every patient is a king or a 
 queen ! " Lister looked with somte surprise at 
 his interlocutor, but preserved silence. 
 
 Shortly after this Lister was called to operate 
 upon a lady of less romantic royalty. Queen 
 Victoria was suffering! from a painful abscess, 
 alid Lister was summoned to Balmoral by her 
 Majesty's physician. Sir William Jeimer. Lister 
 found the Queen more ill than he expected and 
 Sir William seriously anxious, though he had not 
 made his anxiety public. The abscess bteneath 
 the arm was a large one. Lister prepared to 
 open it with his usual precautions, also making 
 use of a carbolic spray apparatus worked by 
 hand, the nature of which will be described in 
 Chapter XIII, where Lister's full technique will 
 be given. The skin over the abscess was first 
 
 227 
 
Lord Lister 
 
 frozen with ether to allay, the pain. During 
 the brief operation a slight spray of carbolic, 
 passing the shoulder, touched the Queen's face. 
 She complained to Sir William Jenner. 
 " Madam," he replied, in humorous excuse, " I 
 am only the man who works the bellows." The 
 Queen looked at Lister's grave face and smilingly 
 asserted that she liked the smell of carbolic, 
 and Lister was by her gentle tact enabled to 
 proceed. 
 
 The operation was successful. Lister put in 
 a strip of carbolic lint to keep the wound open 
 for drainag'e. But, unfortunately, the matter of 
 the abscess did not come away properly, and 
 the Queen was still feverish and in pain. Lister, 
 disturbed by this unfavourable course, walked 
 alone in the grounds of Balmoral, a lonely walk 
 being his custom when he had a difficult problem 
 to solve. During his cogitations it occurred to 
 him that a piece of indiarubber tubing might 
 form' an excellent path of exit to the discharge 
 of a wound. It is illustrative of Lister's bold 
 faith in himself that, though his patient was the 
 highest lady in the land, he did not hesitate to 
 make her the first subject of this experiment. 
 It is true that the French surgeon M . Chassaignac 
 had already made use of tubes of decalcified 
 bone for a like purpose, but it seem's that Lister 
 had not then heard of the French!man's work. 
 Lister returned from his walk, cut a piece of 
 tubing from the spray apparatus, and soaked 
 it all night in carbolic. In the miorning he 
 
 228 
 
Edinburgh 
 
 made use of it, and at the next dressing, to his 
 " inexpressible joy," the discharge was thin and 
 watery. The Queen made a rapid and complete 
 recovery. Lister, confirmed by his royal experi- 
 ment, adopted rubber drainage-tubes as a part 
 of his practice. 
 
 229 
 
CHAPTER X 
 
 TOO LATE 
 
 The crisis of ill -directed and ill-managed charity, 
 if indeed such shameful misdirection can couple 
 its infamy with the kindlier word, was reachjed 
 in English records in the military hospitals at 
 Scutari in 1854, the first winter of the Crimean 
 War. There more convincingly than anywhere 
 else it was shown how man, directing his efforts 
 of benefit according to the dictates of civilization, 
 could nevertheless make for himself a harbourage 
 of pestilence and death. The terrible tale has 
 often been told, and I need only briefly dwell 
 upon it in its less known surgical aspects in 
 order to show how, in times that elder folk can 
 still recall, the tragedy of incompetence stamped 
 itself upon a people who are not yet free from 
 the qualities that gave rise to it. 
 
 The story is inseparably connected with the 
 single efficient person concerned in it, the gentle 
 and commanding lady who cleansed the hK)s- 
 pitals from their grosser impurities. Eor not 
 only were pyaemia, hospital gangrene, and all 
 the horrible forms of blood-poisoning rife 
 amongst the wounded and as sequels to ampu- 
 
 230 
 
Too Late 
 
 tations, but other foul diseases, such as scurvy, 
 typhus, and dysentery, with which Miss Night- 
 ingale was more able to cope, also made these 
 hospitals foetid places of corruption. " In 
 Kululi," she wrote in her report toi the so-called 
 Government, " the worst of all the hospitals, 
 during February, one out of every two cases 
 treated died, and in Scutari and Kululi together 
 two out of every five, in the same month." With 
 each fresh batch of wounded and sick from the 
 front " a frightful increase of mortality occurred 
 immediately, or two or three days afterwards, 
 as far as could be ascertained, among the 
 admissions, who stand such sanitary con- 
 ditions less well than those inured toi them." 
 " The foul air was almost certain death to 
 them ; and accordingly they died, in the month 
 of February, at the rate of 415 per cent, per 
 anmun. So that in twelve months, at such a 
 rate, the whole sick population of thfe hospitals 
 would have perished four times." The hospitals 
 destroyed the army far faster than the home 
 authorities could recruit it. 
 
 Such figures and statements, appalling though 
 they are, appeal to the mind rather than the 
 senses. It is by the senses that one is able to 
 realize the abiding horror of such nests of pesti- 
 lence. " The stench is appalling," wrote William 
 Russell. Others described the rats as they ran 
 from one piece of! diseased and disjoined flesh 
 to another, or even fed upon the mutilated limbs 
 of the miserable sufferers. The picture is so 
 
 231 
 
Lord Lister 
 
 horrible, it would rightly, be buried in oblivion 
 were it not necessary perpetually to remind a 
 people of the supreme need of genius in the 
 direction of affairs at moments when fate 
 demands some prodigious effort^ or when, under 
 the security of peace, the good intentions of 
 ordinary men have become the motives of policy, 
 with the resulting inevitable confusion of meddle- 
 some mediocrity. 
 
 With these pictures of the Crimean War before 
 them, one would have thought that all European 
 lands would have given the question of military 
 medical management earnest attention. Above 
 all one would have expected France, our ally 
 in the Crimea and sufferer from incompetence to 
 an even greater extent than ourselves, to have 
 been most careful to promote efficiency. But 
 France was proudly in the van of the experiments 
 in government with which modem Europe has 
 been so busy. Infused by democratic principles, 
 she had destroyed any continuity of responsi- 
 bility. There was, therefore, no family or class 
 whose duty it was to remember and store up 
 the lesson of the Crimea. The lesson fell un- 
 heeded, and in the Franco -German War the ter- 
 rible harvest of disaster, France's just reward in 
 this life of retributive justice, was reaped. 
 
 Prussia, profiting bly some bad experience in 
 the Austrian War of 1866, and guided by the 
 ascendant genius of Bismarck, fell into no such 
 errors. All the most capable men were given 
 
 peculiar authority coupled with personal respon- 
 
 232 
 
Too Late 
 
 sibility. In the medical department as in the 
 other departments the Prussians went into the 
 war with the knowledge of efficiency. " Our 
 sanitary organization," wrote a Prussian authority, 
 on the eve of the outbreak, " may now compete 
 with the best in the world." For field-service 
 the training of officers and men was remarkably 
 efficient. To avoid the evils of overcrowded 
 hospitals or the paralysis of centralization, a 
 large medical division was trained to break up 
 into smaller and independent components. It 
 was thus able to form a number of small hospital 
 staffs, each one of which was able to care for 
 so many sick and wounded and to save those 
 under their charge from the fearful dangers that 
 attach to a large, unwieldy collection of the un- 
 healthy. In addition to these divisible staffs, 
 twelve light hospitals were provided for every 
 30,000 combatants. Each soldier also carried 
 as a part of his kit a tin of dressings, the tin 
 bearing the number of the soldier so that he 
 could at once be identified and placed. So 
 many men in each regiment were also already 
 trained in the elements of military surgery, lest at 
 any time the numbers of the regular staff should 
 be deficient. One soldier in every eight was pre- 
 pared, if called upon, to carry out emergency 
 duties. All likely to be concerned with the 
 wounded were instructed in the safety of the 
 open air and the danger of crowded rooms. 
 There was a large supply of medical wagons with 
 surgical instruments, dressings, and stretchers for 
 
 233 
 
Lord Lister 
 
 following each regiment. The Army Medical 
 Service was given the first choice of any build- 
 ing or water supply in town or village. Nothing 
 that might bring about a disciplined efficiency 
 was left undone. The chief of all this medical 
 organization himself bore the appropriate name 
 of Dr. Grimm. No wonder that the army doctors 
 said, " So may the war begin : we are prepared 
 to vanquish some of its terrors." The know- 
 ledge, however, of Listerism came to the Ger- 
 mans too late for use in this grand organization, 
 and much human suffering that might have been 
 allayed resulted. 
 
 Nevertheless the Germans were right in their 
 confidence and amply rewarded for their effi- 
 ciency. All the earlier medical reports of the 
 war showed how skilfully the Germans staved off 
 the crippling disaster of disease. Much as the 
 world marvelled at the rapidity and exactitude of 
 the movements of the troops, military surgeons 
 of other nations marvelled yet more at the ability 
 of the medical department in keeping such vast 
 numbers of men comparatively free from disease. 
 The soldiers were picked men, it is true, the 
 authorities sending no raw and ill -disciplined 
 striplings to the front as did the French. The 
 soldiers were instructed in the rules of health 
 and slept out in the open freely to avoid the 
 contagion of infected houses. Later, when they 
 came into close contact with the French at Metz 
 and Sedan, the French revenged themselves 
 upon their conquerors in some small degree by 
 
 234 
 
Too Late 
 
 spreading amongst them the diseases . bred of 
 mismanagement. But on the whole the con- 
 fidence of the Germans in their efficiency was 
 justified. 
 
 Though they were able to defend themselves 
 with considerable success against typhus, dysen- 
 tery, and other military epidemics, they were 
 not able to free the wounded from' the perils of 
 pyaemia and blood-poisoning. Here, also, their 
 record was not so terrible as those of the past. 
 The keeping of patients in the open air, and in 
 buildings the ample ventilation and avoidance of 
 overcrowding were beneficial, but not sufficient. 
 The great weapon of defence. Lister's antisepsis, 
 was wanting. Some surgeons had heard of the 
 work that had been done in Scotland, but the great 
 majority were as yet ignorant. Shortly after the 
 war, with the horrors of the war still haunting 
 them, they became devoted and enthusiastic 
 followers of Listerism. But the saving of life 
 and limb they could then have effected was un- 
 fortunately missed by a brief interlude of time. 
 
 Many of them, however, knew something of 
 the power of carbolic acid. Many surgeons 
 syringed out wounds with solutions of the acid 
 or Condy's Fluid, and with experience they came 
 to trust carbolic more and more. 
 
 A number of different ways of using it were 
 employed. In addition to the syringing, the 
 principal method was to soak charpie, composed 
 of strips of lint, in a solution of carbolic and to 
 lay it upon the wound. But no precautioms 
 
 235 
 
Lord Lister 
 
 were taken to prevent the volatilization of the 
 carbolic, which was one of Lister's essential 
 principles. Superficial wounds did well, but 
 deeper wounds led to the tragedies of pysemia, 
 ulceration of the arteries with sudden outbursts 
 of blood and all the horrors that await upon 
 decomposition. "As for dressing exactly ac- 
 cording to Mr. Lister's plan," said one witness 
 well versed in Lister's methods, " I saw none 
 of it anywhere." 
 
 The record, then, of the more serious wounds 
 and operations was the old record of failure. 
 There is no need to draw again the sinister 
 picture the German surgical hospitals presented. 
 A few figures and facts will suffice . Amputations 
 gave particularly evil results. Stromeyer is said 
 to have amputated thirty-six times through the 
 knee-joint, until death in each case impelled him 
 to desist. Von Nussbaum', who later was to be 
 Lister's chief German disciple, had almost similar 
 results, losing a succession of thirty -four. Such 
 a fell mortality negatived completely, the mercy 
 of the surgeon's knife and gave it a place beside 
 the unerring edge of the guillotine. " In the 
 lower limb," a report ran, " scarcely an ampu- 
 tation recovered, death resulting from exhaustion 
 and sloughing of the flaps, and frequently from 
 pyaemia." " Pyaemia raged here as elsewhere," 
 was the tale of another report. Hospitals were 
 " hotbeds of pyaemia ... in spite of the most 
 perfect arrangements." A freshly erected or 
 organized hospital kept free from blood-poison- 
 
 236 
 
Too Late 
 
 ing for a few weeks, and then the diseases of 
 decomposition began with increasing frequency 
 and virulence to. seize upon their victims. Only 
 the worst form', that of hospital gangrene, for 
 some unknown reason was comparatively rare. 
 
 The French surgeons on their part had had 
 the advantage of experience in the Crimean War 
 and in the Italian campaign of 1859. They, 
 moreover, possessed Pasteur for their country- 
 man, whose name by that date was famous 
 amongst all Frenchmen, who followed science. 
 Theirs also was the country in which the first 
 Napoleon had organized his marvellous armies 
 and had given to the medical departments such 
 a share of the extraordinary efficiency that 
 radiated from him as comported with the objects 
 of war. 
 
 But the French had interrupted the tradition 
 of Napoleon and mingled it with memories of 
 feebleness. Their experiences in the Crimea and 
 Italy had appalled them, but had not produced 
 any man of mastery. They had no man like 
 Bismarck to imbue everything with power and 
 capacity. 
 
 As a consequence, in spite of their recent ex- 
 perience, in spite of their goodwill, in spite of 
 all things that should, were it possible, make 
 commonplace men men of mastery, the French 
 military system, and with it the medical system, 
 like a child's tower built of cards, fell to 
 pieces under the first pressure that was put 
 upon them. From all sides came reports of 
 
 237 
 
Lord Lister 
 
 the same dolorous tale of helpless inefficiency. 
 Utter disorganization followed the first check. 
 Like the tissues of the frog's web which Lister 
 saw paralysed by injury, so a paralysis seized 
 the French after the initial injuries. They had 
 as a nation destroyed those born to high places 
 and to the habit of responsibility and command. 
 They had given Europe a tremendous picture of 
 the forces of liberty. They had followed it with 
 a yet great picture of the power of supreme 
 genius. They were now destined to give a 
 picture of a nation who had lost its governing 
 caste and tradition, and were trusting to such 
 chance leaders as liberty and the caprice of the 
 people without definite standards may supply. 
 
 The result in the medical department was ter- 
 rible. Goodwill was paralysed by ineptitude. 
 " An absence of all administration prevailed on 
 every side." This condition of maladministra- 
 tion was soon succeeded " by one of apathy and 
 indifference." Am.ongst the sick and wounded 
 the resulting suffering was horrible. "It far 
 surpassed anything that prevailed at Scutari in 
 the worst of times." Happy the wounded 
 Frenchman who escaped the merciless impotence 
 of his countrymen and endured the iron clemency 
 of their conquerors 1 The tale of disaster 
 attained its climax in the besieged capital. The 
 wounded were crowded into the hospitals of 
 Paris. Large buildings and private houses were 
 filled with the overflow. And then death in all 
 its most monstrous and horrific forms entered to 
 
 238 
 
Too Late 
 
 eiripty them and provide space for a fresh inflow 
 of doomed men . Hospital gangrene and pyaemia 
 raged with a virulence that surpassed all previous 
 disasters. Whilst Listerism lay at hand, that 
 which it was to destroy rose up. and as a last 
 effort dealt its most fearful blow to mankind. 
 One passing along the streets of Paris recoignized 
 at a distance a surgical hospital owing toi the 
 stench' of the human putridity it contained. 
 Ninety out of every hundred men who suffered 
 amputations are said to have succumbed, whilst 
 ten secured a sickly tenure of crippled life. In 
 all the Erench seats of the war the results of the 
 surgeon's craft were scarcely better. The official 
 figures of Inspector-General Dr. J. C. Chenu 
 reported that there were 13,173 amputations of 
 all sorts, including lesser ones such as those of 
 fingers and toes, and of these 13,173, 1 0,006 
 died. Such was the frightful mortality of the 
 beneficent surgical art. " Ce n'est pas sans une 
 profonde doleur," wrote General Chenu in his 
 Introduction, " que nous avons entrepris ce 
 travail, qui va rappeler les malheurs de la 
 France." 
 
 Yet Pasteur, who had enlightened Lister, was 
 working in the Ecole Normal in Paris until 
 the September before the siege began. By the 
 advice of his friends he, " a useless mouth " in 
 the coming hunger, retired to Arbois to save 
 himself for those labours in the silk, agricul- 
 tural, and brewing industries, which led to such 
 increased prosperity that he alone may be said 
 
 239 
 
Lord Lister 
 
 to have paid the £100,000,000 of indemnity 
 to Germany. One wonders he did not urge the 
 adoption of Lister's methods, but his understand- 
 ing of surgery, was perhaps insufficient to enable 
 him properly to estimate the value of antisepsis. 
 
 Two prominent Parisian surgeons, Drs. 
 Alphonse Gu^rin and Maisonneuve, had both 
 been counted by Sir James Simpson as Lister'$ 
 predecessors. Both had for some time made use 
 of carbolic acid, but there their resemblance to 
 Lister ceased. Dr. Maisonneuve had had better 
 success than most surgeons, and enjoyed the 
 repute of being the leading man in his pro- 
 fession. Yet in the H6tel Dieu, where he 
 worked, every case of amputation thtough the 
 thigh ended in death. In all the Parisian 
 hospitals during the war it was the same tragic 
 tale. Even in the wooden-huts hospital at Passy 
 pyasmia and other blood-poisonings killed every 
 patient who underwent an amputation. 
 
 Thus throughout the war, which followed 
 three years after Lister's publication of his early 
 successes at Glasgow, there was no member of 
 his profession who gave its incomparable benefits 
 to the vmfortunate wounded. It was said by some 
 in excuse that antisepsis was too complicated 
 and required too much time and care to be 
 employed in military field surgery. But had any- 
 one grasped Lister's principles, nothing could 
 have been easier than their practical application. 
 
 The dictatorship of a military period would 
 have been peculiarly suitable for bringing about 
 
 240 
 
Too Late 
 
 the general adoption of Lister's principles. At 
 times of peace a general adoption of a profitable 
 innovation can only be made by some imperial 
 paternal system, such as the Russian or Japanese, 
 which have carried out vast and sudden changes 
 without revolution or even marked commotion. 
 The Prussian system also admitted of rapid adop- 
 tion of any new method approved of by the 
 highest authority. In short, any system in which 
 the paternal principle existed and in which one 
 voice could command all in a matter of benefit, 
 a striking improvement can be quickly and effec- 
 tually generalized. Otherwise only the tempo- 
 rary existence of a system of discipline during a 
 war provides the means of quick and general 
 adoption. There was as great opportunity for 
 such a beneficial and general adoption of Lister's 
 principles during the Franco-German War, but it 
 was not taken. 
 
 Lister himself, upon the outbreak of the war, 
 had published a pamphlet giving a simple means 
 of antiseptic treatment " applicable to wounded 
 soldiers in the present war." By this he made 
 the general adoption of his invaluable treatment 
 possible, and had Pasteur's countrymen made use 
 of it it might even have turned the scales of fate 
 in their favour. At least the destruction of the 
 soldiers would not have been nearly so great, 
 wounded men in many cases would have been 
 rapidly restored to fighting capacity, and the 
 army would have been freed from the paralysis 
 caused by the enormous number of sick mien. 
 
 241 Q 
 
Lord Lister 
 
 The materials needed for the treatment, which 
 Lister described in his pamphlet, were simple 
 enough, and the mode of using them was equally 
 simple. There were no grounds whatever for 
 the excuse that the antiseptic treatment was too 
 complicated for use in field work. The reader 
 can judge as to its simplicity from the following 
 condensation of Lister's pamphlet, which only 
 occupied four pages of print : — 
 
 After the woimd had been washed out with 
 carbolic lotion and any bleeding arteries had been 
 secured by antiseptic ligatures, the wound was 
 to be covered first by a slip of oiled silk smeared 
 with carbolic oil, then with a piece of lint or 
 rag soaked in the oil, then a piece of thin gutta- 
 percha tissue overlapping the lint, once more 
 a piece of lint or rag or towel, wrung out in 
 oil, finally a second piece of overlapping gutta- 
 percha tissue, and the whole bandaged on to 
 the wound. As blood soaked into this dressing, 
 wrote Lister, the outer layer of lint, rag, or towel 
 should be squeezed out and soaked afresh in 
 the oil. When the discharge had ceased', damp- 
 ing of the outer layer with the oil every two 
 days would be sufficient. 
 
 The lay reader will see at once how simple 
 this dressing was, and can, perhaps, share with 
 the medical mind an admiration of its perfec- 
 tion. The inner dressing did not have to be 
 removed at all, and so the healing wound was 
 left completely at rest and the great pain of 
 its disturbance avoided. Only the outer layer, 
 
 242 
 
Too Late 
 
 separated from the wound, was touched by the 
 dresser. 
 
 The treatment also showed a bold faith in the 
 healing power of nature. After being protected 
 the wound was left entirely to itself. In this, 
 this dressing seems to me as perfect as any 
 imaginable for a wound incurred in war. Had 
 it been used by the military surgeons, a thousand 
 wounds that admitted death would have been 
 shielded, while life and vitality were renewed. 
 But such is the way of men that it needed the 
 experience of this war and the horrors of putre- 
 faction in living sufferers, which they witnessed, 
 to bring to them a conviction that came too late 
 to wipe off from the slate of history a story of 
 irreparable woe. 
 
 243 
 
CHARTER XI 
 
 THE FURTHER SPREAD OF THE GOOD TIDINGS 
 
 The surgical horrors of the Franco -Prussian war, 
 being at a distance, did not make a deep impres- 
 sion upon British medical men. A few British 
 surgeons did go to the seat of the war to join 
 with the Americans in the Anglo-American 
 ambulance. The chief surgeon of this ambu- 
 lance was Mr. William MacCormac, of Belfast, 
 who had already expressed his adherence to 
 Listerism, though modifying Lister's technique. 
 But apparently he did not carry out a complete 
 antiseptic treatment in the many operations he 
 performed when his ambulance was at Sedan, 
 for his dresser. Dr. Ryan, reported that there 
 was no real antisepsis of the instruments and 
 addenda. The results obtained, though better 
 than elsewhere, were not in any way striking. 
 
 In 1 87 1 Lister was given a peculiar oppor- 
 timity to bring his views forward. 'He was 
 chosen to deliver the address in surgery before 
 the British Medical Association's Annual Meet- 
 ing, which in that year took place at Plymouth. 
 
 His repute was growing, and men were anxious to 
 
 244 
 
Further Spread of the Good Tidings 
 
 have an opportunity of considering if he was 
 to prove the greatest benefactor of their art or 
 a fanatic with an ephemeral panacea. 
 
 Lister's address was one of considerable 
 eloquence, and, indeed, it is notable that as the 
 subject of his heart revealed itself to him in 
 all its great power, so his language gained a 
 ripeness and volume suitable to its exposition. 
 
 It was customary for this annual address to 
 take the form of a general review of surgery, 
 but Lister felt that he, at least, was not expected 
 to follow any precedent. Men wanted to hear 
 about his unprecedented work and proclaimed 
 success. So he began at once with the subject 
 of the antiseptic treatment— a treatment which 
 " is calculated, I believe, to revolutionize every 
 department of surgery." The fact that his name 
 was associated with this topic, he continued, made 
 him shrink from adopting it, but " this connection 
 has in all probability led to my standing before 
 you to-day." 
 
 He went on to urge his hearers to accept the 
 germ theory as an act of faith. " Few medical 
 men in active practice have the leisure to sift 
 and weigh the facts and arguments of such a 
 discussion," he said. If they would take the 
 theory as an act of faith, then in their practice 
 he could promise them good results. But more 
 he could not promise, unless they could come 
 to Edinburgh and personally study with him and 
 witness his procedure. Disciples converted by 
 print he found were disciples only in part. By 
 
 24S 
 
Lord Lister 
 
 " mere description " he could not confirm their 
 practice. Such was one of the great difficul- 
 ties with which both he and they had to contend. 
 Personal discipleship is always necessary to 
 the proper adoption of a new doctrine. Come 
 and see is alone suitable to matter o|f real 
 value. Come and hear belongs toi more evasive 
 doctrine . 
 
 A detailed account of the address is needless. 
 It contained the same insistence upon Pasteur's 
 theory and the same demonstration of Pasteur's 
 initial simple experiment. Lister met the critics 
 of this experiment with some warmth. " I con- 
 fess, Mr. President, I am ready to blush for the 
 character of our profession for scientific accuracy 
 when I see the loose comments somietimes made 
 upon this experiment ; and I am tempted to 
 doubt whether some of the commentators can 
 have enjoyed the advantages of sufficient educa- 
 tion either in chemistry, physics, or logic. The 
 simplicity and perfect conclusiveness of the 
 experiment constitute its great charm, and render 
 it, as it appears to me, deserving of your careful 
 consideration." 
 
 Lister passed from the germ theory to the 
 methods of his practice and their results, and 
 was able to declare that his Edinburgh wards 
 continued to preserve a freedom from blood- 
 ipoisoning. 
 
 Finally he declared that, in view of these 
 results, he was surprised at the apathy shown 
 in many quarters to a treatment so beneficial 
 
 246 
 
Further Spread of the Good Tidings 
 
 to sufifering humanity, and concluded with the 
 language of Macbeth :— 
 
 " Can such things be, 
 And overcome us Uke a summer's cloud 
 Without our special wonder ? " 
 
 For some reason this address seemed to have 
 aroused more resentment than anything else. 
 One thinks, perhaps, it was because Lister taught 
 as one with authority, and not in the customary 
 manner of Association addresses . To declare that 
 what he taught would revolutionize every branch 
 of surgery was to suggest that surgery and its 
 practitioners were in a bad way, and was very 
 different to the conventional flattery which large 
 gatherings expect. 
 
 For the next two years there was a lull of 
 interest, and the opposition of apathy rather than 
 attack. Indeed there was little to attack, for 
 none could deny Lister's results at the Edin- 
 burgh Infirmary nor those of the men " scattered 
 up and down in this country and in various parts 
 of the world," who, " having witnessed the treat- 
 ment in our wards, whether as students or quali- 
 fied practitioners, are attaining exactly the same 
 results as we do." 
 
 An opportunity of attack, not upon the results 
 but upon the theory, arose from the experiments 
 of Dr. Charlton Bastian, a young London 
 physician, which, like the previous experiments 
 of Dr. Hughes Bennett, by their varied results 
 apparently disproved the germ theory of Pasteur. 
 
 247 
 
Lord Lister 
 
 Something had turned the Lancet, hitherto 
 Lister's chief advocate in London, against him. 
 One cannot think that as the chief London paper 
 it felt compelled eventually to range itself with 
 London's hostility to Lister, but whatsoever it 
 was, its attitude assumed the form of avowed 
 personal opposition, which collects with illogical 
 zeal any points that seem to tell against an 
 opponent. From this time onwards Mr. Wakley 
 allied himself with the obstinate jealousy that 
 London surgeons showed to the growing fame 
 of the Edinburgh professor. In the light of 
 his original and singular championship, I con- 
 fess that I know of no explanation of the change. 
 Nevertheless, a certain bitter tone that accom- 
 panied it seemed to preclude it being due to 
 an impartial and unprejudiced disbelief in 
 Pasteur's germ theory. 
 
 Thus, following upon Dr. B'astian's work, the 
 Lancet in 1873 devoted a leading article decry- 
 ing the germ theory. The writer did not, of 
 course, deny the success Lister himself had had 
 with the " now celebrated antiseptic system," but 
 he took the curiously illogical view that the 
 thought upon which the system was based was 
 rotten, and hence by allusion attributed Lister's 
 success to some providential and inexplicable 
 chance. " Would M; Pasteur, in the present 
 state of science, still attempt to uphold his vital 
 theory of fermentation?" Would Professor 
 Lister still give " an unqualified adherence to 
 the doctrines of M. Pasteur"? But neither of 
 
 248 
 
Further Spread of the Good Tidings 
 
 these great scientists turned from the truths 
 of their own experiments to the contradictions of 
 others. 
 
 The Lancet followed this attack with a 
 further article, in which the writer made a 
 deliberate attempt to belittle Lister's bacterio- 
 logical work upon the grounds of its chief merit, 
 namely, its simplicity. This curious objection 
 seems, one thinks, to indicate personal spite in 
 a writer, who declared that he found it " difficult 
 to see, from the facts he has brought forward, 
 why Professor Lister should have thought him- 
 self entitled to any definite opinion upon this 
 part of the theory." Lister did not reply to 
 either of these articles. 
 
 An even stranger attack occurred in the 
 following year. Mr. Gamgee, of Birmingham 
 and tissue fame, was a man with original views 
 upon the treatment of wounds. Baffled by the 
 conflicting opinions upon Lister's teaching, he 
 offered himself as an impartial critic in order 
 to deliver a public and, it was to be hoped, 
 decisive judgment. 
 
 Lister, of course, did not refuse. Mr. 
 Gamgee came to Edinburgh, and all the 
 evidence was laid before him. In his pub- 
 lished report he bore testimony to Lister's good 
 results, some of which he said were " brilliantly 
 good." But his comments upon the thought and 
 theory that had produced these results were in 
 no way appreciative. Mr. Gamgee could not 
 bear to see his own idols dispossessed. Mr. 
 
 249 
 
Lord Lister 
 
 Lister, he said, most unwisely ignored " the mar- 
 vellous efficacy of two such remedial principles 
 as compression and suspension (hyponarthesis, 
 not mere elevation), and does not at the same 
 time weigh the relative advantages of moist and 
 dry, of frequent and rare dressings." Neglecting 
 these valuable principles, Mr. Lister had pinned 
 his faith to the theory of Pasteur and adhered 
 to it with imfiinching fidelity. And this in spite 
 of criticism, in spite of the floods of contradic- 
 tory experimental results that kept pouring in 
 from different observers ! These results would 
 infallibly crush Lister's faith in the germ theory 
 were it not that the Edinburgh professor was 
 possessed of an obstinacy which ignored facts 
 as well as the great advantages of hyponarthesis. 
 Such was Mr. Gamgee's judgment. Lister, 
 rarely drawn into controversy, felt compelled to 
 reply to a judgment that had been given under 
 circumstances of peculiar state and publicity. He 
 answered with his usual terse irony and 
 directness. 
 
 " Mr. Gamgee in his report," he wrote in the 
 British Medical Journal, " says that I have 
 adopted on insufficient grounds a theory which 
 ' is made to fit all difficulties, and is itself main- 
 tained immutably in the presence of a succession 
 of very varying facts.' 
 
 " Whether or not I deserve the grave charge 
 thus publicly alleged against my professional 
 character it would be imbecoming for me to dis- 
 cuss in your columns, but I trust that some at 
 
 250 
 
Further Spread of the Good Tidings 
 
 least among your readers will draw a broad line 
 of distinction between the facts which Mr. 
 Gamgee has recorded and his comments upon 
 them." 
 
 Meanwhile personal discipleship was slowly 
 converting medical men to Lister's doctrine. 
 Some practitioners visited Lister, studied with 
 him, and returning to their practices found them- 
 selves the masters of security and not the sport 
 of chance. As " humble exponents of the views 
 of a most able surgeon " they bore witness to 
 their success. Among the ranks of the leading 
 surgeons Mr. Lund, of Manchester, went to 
 study with Lister, and urged with enthusiasm 
 the general adoption of this wonderful treatment. 
 In Scotland, at Glasgow, Aberdeen, and Edin- 
 burgh, the adherents of Lister were numerous. 
 As Sir Robert Christison told the Board of the 
 Edinburgh Infirmary, when they complained 
 about the expense of the carbolic compared to 
 the water dressings, the use of antiseptics, at 
 first confined to Lister's wards, was very general 
 throughout the infirmary. Nevertheless, even in 
 Edinburgh the recognition of Lister was very 
 partial, and Professor Caird, when an Edinburgh 
 student in 1874, was told to "have nothing to 
 do with Lister ; he is hop>elessly unorthodox," 
 although his wards were pure, whereas in some 
 others patients died " like sheep upon the hill- 
 side." 
 
 Of public men of enlightenment Professor 
 Tyndall was a strong supporter of Pasteur's 
 
 251 
 
Lord Lister 
 
 theory and Lister's treatrntent. Professor Huxley, 
 himself a qualified surgeon, personally visited 
 Lister and leagued himself with his friend 
 Tyndall. " What amazes me, Mr. Lister," he 
 said on the occasion of his visit, " is the pain- 
 lessness of your wounds. You have not only 
 banished those awful scourges which used to 
 affect our wards, but you have abolished the 
 pain and suffering associated with wounds and 
 surgery." 
 
 The London surgeons, however, remained 
 obdurate, confirmed in what the Catholic theo- 
 logian terms invincible ignorance. Only one 
 whole-hearted testimony came from London in 
 these years, and by a singular irony it heightens 
 instead of mollifies the stubborn neglect of the 
 London medical world. This testimony was from 
 Dr. Lichtenberg, a German surgeon attached to 
 the German Hospital in Tottenham. 
 
 Dr. Lichtenberg, however, came from a 
 country which in assimilating the science of 
 the age brooked no rival. There can be no 
 doubt that the distinctive feature of the last half- 
 century of European history has been the 
 efficiency of Germany. No country has paid 
 greater heed to the claims of intellect nor given 
 so large a body of university scientists and 
 doctors a freedom from financial cares that they 
 may the more disinterestedly pursue the paths 
 of knowledge. The medical profession, both 
 before and after the Franco -German War, shared 
 
 very largely in the general efficiency, and, with 
 
 252 
 
Further Spread of the Good Tidings 
 
 the one exception of Professor Saxtorph, it was 
 in Germany that the power over disease, which 
 Lister had devised, was first generally recognized 
 as possessing the supreme value which sub- 
 sequent generations have accorded to it. 
 
 The horrors of blood-jxiisoning had been 
 vividly impressed upon the surgeons who had 
 taken part in the war. Many a dreadful sight 
 was stamped upon their memories and returned 
 in graphic pictures to their minds whensoever 
 thought or conversation dwelt upon their experi- 
 ences. Many of Lister's first German disciples 
 owed their early and complete conversion to the 
 awful seriousness with which they had come to 
 regard pyaemia and hospital gangrene during and 
 after the war, when sick men were many and 
 hospitals overcrowded. Von Langenbeck, von 
 Esmarch, von Volkmann, von Nussbaum, and 
 many others had been convinced of the utter 
 need of a surgery that was less closely allied to 
 pain and death, and of the hopefulness of 
 carbolic and other antiseptics. " We have to 
 thank the use of carbolic for much good," wrote 
 von Nussbaum, who more than any other man 
 was to startle the world with the wonders 
 of Listerism, writing from the seat of the war. 
 A few weeks later, writing from Orleans, his praise 
 of the carbolic dressings was much warmer. 
 " Carbolic is a godsend. You must know that 
 this discovery of Lister's has worked wonders. 
 . . . Fractures due to shot are particularly suit- 
 able for Lister's method ; and if you ask me how 
 
 3S3 
 
Lord Lister 
 
 I would recommend you to dtess such fractures 
 and evil-looking shot waimds, I would tell you 
 with all the emphasis at my coimmand to use 
 the carbolic dressings and them alone." 
 
 After the war von Nussbaum returned to the 
 Munich State Hospital, where he was chief 
 surgeon. This hospital was at this time in a 
 clean condition, but as more and more wounded 
 men were brought to it, and the growing indus- 
 tries of Munich led to a larger poor population, 
 it soon became permanently overcrowded. As 
 a result the terrible hospital gangrene occurred. 
 Von Nussbaum's use of carbolic failed before this 
 loathsome disease. In 1872, 26 per cent, ojf 
 wounded or operated patients were attacked. In 
 1873 the figures mounted to 50 per cent. ; and 
 in 1874 hospital gangrene, "gnawing at the 
 wounds like a wild beast," as von Nussbaum 
 graphically described it, slew or permanently 
 crippled eighty out of every himdred surgical 
 patients. This was a calamity almost without 
 parallel, except in besieged Paris. " The clean- 
 liness and neatness of these wards does not 
 deceive me," said a distinguished visitor, " I 
 deplore both you and the patients who are sent 
 to your wards, for they are but lightly concealed 
 graves." 
 
 Von Nussbaum, who was a man of noble 
 character, sank into despair. He suffered un- 
 endurable mental agonies. He had tried every 
 treatment, the open treatment of wounds by 
 which they were left uncovered, the old forms 
 
 2S4 
 
Further Spread of the Good Tidings 
 
 of dressing, and the carbolic with which he had 
 previously had success. All was in vain. His 
 wards were filled with the stench of foulness 
 and the sharp cries of agony. At last a happy 
 idea occurred to him. Why should he not appeal 
 to Lister for help? At any rate there was none 
 other to whom he could turn. So he dispatched 
 one of his assistants, Dr. Lindpainter, to Edin- 
 burgh, to spend such time as would make him 
 master of Lister's full technique and treatment. 
 Upon Lindpainter's return von Nussbaum laid 
 his wards under the sternest and minutest 
 Listerian regime. The result was a complete 
 transformation. The horrible gangrene vanished, 
 as a mist rolls back before the sun. 
 
 In an address that became famous, delivered 
 in April, 1875, von Nussbaum paid a glowing 
 tribute to Lister. " Lister's Great Discovery " 
 was its title. " Lister's treatment," he declared, 
 " is already being greeted by the whole civilized 
 world as an enormous advance. Everything new 
 receives criticism, and Lister's methods have been 
 much criticized, but such proofs can be obtained 
 from it that one has no use for any words but 
 those of gratitude and admiration. ... It 
 repays trouble a thousandfold. . . . Look now 
 at my sick wards, recently ravaged by death. 
 I can only say that I and my assistants and my 
 nurses are overwhelmed with joy and undertake 
 all the extra trouble the treatment entails with 
 the greatest zeal. The happiest mood possesses 
 us, whilst before we went about with hanging 
 
 2SS 
 
Lord Lister 
 
 heads. What wonders of conservative surgery 
 has the future in store for us I " 
 
 Von Nussbaum made his discipleship not only 
 eloquent but thorough. He countered the ridi- 
 culous accusation of cost that was sometimes 
 brought against Listerism by showing the enor- 
 mous economy brought about by its efficacy in 
 restoring people to health. Chronic invalids were 
 no longer manufactured by the hospital to be 
 turned out upon a heavily burdened State. There 
 was no longer the big bill for coffins. There 
 was no longer any need to evacuate hospitals, 
 or even to pull them down, as the only means 
 of getting rid of infection. 
 
 Von Nussbaum went farther. With Dr. Lind- 
 painter he produced the first statistical proof of 
 the results of antisepsis. It was published in 
 the Deutsche Zeltschrift fiir Chirurgie in October, 
 1876, and contained separate accounts of every 
 case that had been admitted to hospital. All 
 had been treated by Listerism, and the results 
 were overwhelmingly in its favour. 
 
 Professor von Volkmann, of Halle, anticipated 
 the Mimich professor in the full adoption of 
 Lister's methods. He also had the same experi- 
 ence upon returning from the front. Indus- 
 trialism had already led to a greater demand 
 upon the hospital, and the war made this over- 
 crowding final. Then pyaemia and hospital 
 gangrene arose to empty the wards that had 
 become so overfilled. In the winter of 1872 
 these diseases were so ruthless that von Volk- 
 
 256 
 
Further Spread of the Good Tidings 
 
 mann proposed to close the hospital before the 
 destruction to which it had been condemned 
 began. It was then, however, that he, fortu- 
 nately, heard of Lister's work. He imme- 
 diately procured all Lister's papers, and carefully 
 studied and cautiously practised every detail of 
 treatment that he found in them. Von Volkmann, 
 indeed, seems to have been the one surgeon who 
 succeeded in securing the full benefits of the 
 antiseptic treatment without paying a personal 
 visit to Edinburgh or sending one of his 
 assistants. It is true that his friend. Dr. 
 Schultze, visited Lister in 1873 ^^^^ wrote a full 
 description of the system for von Volkmann's 
 " Collection of Clinical Lectures," but by that 
 time the antiseptic system had been installed in 
 the Halle Hospital for several months. 
 
 Not only did von Volkmann learn the anti- 
 septic treatment from what he read, but his 
 results were equal to those of Lister himself, 
 and in the case of chronic abscesses even sur- 
 passed Lister's. Of seventy-five patients suffer- 
 ing from compound fracture all recovered without 
 loss of limb. Of 139 patients upon whom ampu- 
 tation was performed only four died, and two 
 of these soon after the operation owing to the 
 shock of the initial accident. Yet but recently 
 before the introduction of antisepsis the deaths 
 from amputation had been as much as ten to 
 twenty times as many. Of the many patients 
 who had received the dangerous open wounds of 
 joints not one treated by von Volkmann died. 
 
 257 R 
 
Lord Lister 
 
 He, moreover, dared many new kinds of opera- 
 tions, which previously he would have considered 
 homicidal. The results were truly magnificent. 
 The antiseptic treatment in his hands proved a 
 veritable talisman of life. His results were lifted 
 at once to a level that is rarely, if ever, attained 
 by the best surgeons of to-day. They were 
 secured in a small and overcrowded hospital, 
 appropriately built over one of the largest sewers 
 of the town. Previous to the introduction of 
 antisepsis it had had so evil a reputation for 
 hospitalism that it had been condemned to 
 demolition. But von Volkmann, without any of 
 the architectural and mechanical extravagances 
 of the modem hospital, changed this trap of 
 charity into a true blessing to the sick and 
 wounded. ' 
 
 Before von Volkmann in actual precedence in 
 adopting Listerism' was Professor von Thiersch, 
 who had been appointed the chief surgeon to the 
 Leipsig Hospital. " It was one of the worst 
 hospitals," he said. Pyaemia and hospital gan- 
 grene held their customary resistless sway. Like 
 the two great German surgeons already men- 
 tioned, von Thiersch was a man of noble and 
 devoted character. Horrified at the constant 
 spectacle of agony and death, he had, by con- 
 tinuous agitation, prevailed upon the authorities 
 to abandon the building in which he worked, 
 with all its furniture and fittings, and to erect 
 and equip another, Eor a time all went well 
 in the new building, and then one day an un- 
 
 258 
 
Further Spread of the Good Tidings 
 
 happy patient was seized with the dread 
 gangrene. Appalled by the resistless cruelty 
 that pursued his patients, von Thiersch, instead 
 of sinking into apathy at what he could not 
 prevent, searched energetically everywhere for 
 help. He read the first papers Lister published 
 in 1867, and forthwith adopted the new treat- 
 ment. Later, however, he substituted salicylic 
 acid for carbolic, as being less caustic and less 
 volatile. Our results, he said in 1875, "are 
 not so good, it is true, as those of Lister himself, 
 or of von Volkmann," but the terrors of the 
 past had been totally abolished. He also pub- 
 lished an account of 160 cases, with full details 
 of treatment, results and cost, and the 
 characteristic German thoroughness. 
 
 In Berlin Professor von Bardeleben, who paid 
 a personal visit to Lister, had changed the 
 character of his wards. The veteran von 
 Langenbeck, Germany's most distinguished 
 surgeon, had allowed neither his years nor 
 his fame to hinder him from becoming a pupil 
 of Listerism. At Bonn, Professor von Busch 
 was enthusiastic. Indeed, the tale of antisepsis 
 in Germany in the middle seventies would include 
 the records of nearly all the leading surgeons. 
 " Your procedure is unconditionally secure," was 
 the testimony of Professor Hagedom, of Marde- 
 burg, to Lister. In this very security, perhaps, 
 lies a monotony that may weary the reader. Yet 
 how splendid is the record of places of disaster 
 converted to places of renewed life which 
 
 259 
 
Lord Lister 
 
 Germany furnished even at this early date. In 
 the Congress of German Surgeons held in 
 Berlin in April, 1875, under the presidency of 
 von Langenbeck, " there was but one voice, that 
 of praise," said von Nussbaum of Listerism. 
 " Professors von Volkmann, von Bardeleben, von 
 Thiersch, Hiiter, Schonbarn, and Schede could 
 not find words enough to tell of the good of 
 it." Yet at the same time a Congress of 
 London Surgeons was being held with very 
 different results. 
 
 Urged by many invitations from German 
 surgeons. Lister himself paid a visit to some 
 of thte German University towns in June, 1875. 
 Lister, said Sir Hector Cameron, his house- 
 surgeon at Glasgow and lifelong friend, " had 
 no great love of fame. When honours came 
 they seemed always to cause in his mind a sense 
 of surprise, and gave pleasure chiefly because 
 he saw in them recognition of the truth and 
 value of his work." His journey through 
 Germany was the first occasion of those public 
 recognitions that the gratitude of mankind 
 showered upon his latter years. It assumed 
 the actual character of a triumphal march. The 
 greatest conqueror of disease the world has ever 
 seen was regarded by the surgeons, students, 
 and laity of the Fatherland as a conqueror 
 indeed. He went first to Munich, the city of 
 von Nussbaum. He was received with extra- 
 ordinary enthusiasm, and a banquet was given 
 in his honour, at which all the leading medical 
 
 260 
 
Further Spread of the Good Tidings 
 
 men and the members of the Government and 
 municipahty were present. Eulogies, warmed by 
 a profound and genuine gratitude, were delivered, 
 to which Lister replied in the German language. 
 The students of the University on their part pre- 
 pared a special reception, and, one after another, 
 speakers arose to describe the miraculous changes 
 they had effected in the many hospitals of Munich, 
 and to lay this record of mercy and healing as a 
 unique tribute at the feet of him whom they ac- 
 claimed. At Leipsic the scenes were repeated. 
 Professors, jimiors, medical practitioners, and 
 students clubbed together to the number of four 
 hundred and gave Lister a banquet in the Schiit- 
 zenhaus. "Between the speeches," wrote a friend, 
 " and throughout the course of the evening songs 
 were sung by a quartet of students, and a band 
 in the gallery played music of various kinds ; 
 amongst others ' Bonnie Dundee,' ' Coming 
 through the Rye,' etc. There were also two 
 songs composed by students for the occasion, 
 which were sung by the whole mass of students 
 who were present." At Berlin, Halle, Bonn, 
 and Magdeburg Lister's reception was marked 
 by the same profound gratitude and enlightened 
 evidence. Lister returned to Edinburgh, feeling 
 sure that the conversion of the whole civilized 
 world to the same enthusiastic conviction would 
 be only a matter of time. 
 
 In the country of Pasteur Lister also had 
 many adherents, but the acceptance of his system 
 was in no way so enthusiastic nor so enlightened 
 
 261 
 
Lord Lister 
 
 as it was in Germany. Antiseptics were in more 
 or less general use, but without definite principle 
 and plan, and the consequent beneficent results. 
 
 M. Duplay, editor of the Archives Generates 
 de Medecine, published an account of Lister's 
 methods in 187 1. M. Lucas Champonnifere, as 
 editor of the Journal de Medecine et de Chirurgie 
 Pratiques and author of the first text-book of 
 the antiseptic treatment, did his best to convert 
 his countrymen. In 1877 M. Duplay devoted 
 a revue critique to antisepsis. He acknow- 
 ledged that Lister's was the only thorough and 
 effective system. " It has been adopted by a 
 great number of surgeons, not only in Britain 
 but also in Germany, Denmark, and Italy. 
 French surgeons, however, have not shown them- 
 selves much disposed to make use of it." The 
 review was a comprehensive one, but cold. 
 " Perhaps the whole success is due to the one 
 fact that the surgeon himself has to attend to 
 the smallest minutiae of treatment," suggested 
 M. Duplay in endeavouring to find an explana- 
 tion other than the obvious one for a success 
 he freely acknowledged. One is not surprised 
 to find a visitor to Paris in 1877 saying : " The 
 principles of Lister are so imperfectly understood 
 by a good many French surgeons that I had 
 shown me at various hospitals ' modifications ' 
 of his method in which everything is present 
 except his principles." An attempt to make their 
 ideas clearer gave " unintended umbrage " to 
 Gallic vanity. 
 
 262 
 
Further Spread of the Good Tidings 
 
 In Austria, io the large towns, antisepsis found 
 more favour. Professor Billroth, who occupied 
 the premier position in Vienna, sent Drs. Gus- 
 senbauer, Woffler, and Mikulicz -Radecki in 
 succession to Lister, so as to get information 
 at first hand. 
 
 In Italy, as M. Duplay recorded, Lister's 
 method also found more favour than in France. 
 Dr. Clementi, of Catania, in Sicily, gave a full 
 report of its use and progress in 1.874. 
 
 Of the smaller European countries Denmark, 
 under the leadership of Professor Saxtorph, could 
 claim to be the first coimtry in Europe to adopt 
 Listerism with thoroughness. From Sweden 
 came boracic acid, the use of which Lister greatly 
 improved by devising boracic lint and ointment. 
 
 Amongst the Americans, a people practical in 
 the day's affairs but wholly unphilosophical, the 
 acceptation of Listerism was very slow. Lister 
 himself visited the United States in the autumn 
 of 187 6, and attended the International Mtedical 
 Congress in Philadelphia. He delivered an 
 address, but his reception was not marked by 
 any enthusiasm, and the discussion which fol- 
 lowed was described by the leading New York 
 medical paper as " quite interesting." Drs. Van 
 Buren and Stephten Smith were the chief surgeons 
 to take up the antiseptic method, but of a 
 meeting of the American Surgical Association, 
 which took place as late as July, 1882, the 
 Lancet, secure in a recent conversion, reported : 
 " Anti-Listerians were in the majority ; . . . they 
 
 263 
 
Lord Lister 
 
 relied for support upon the statements of others. 
 . . . Surely it is too late in the day to contest 
 the truth of the germ theory." 
 
 The Lancet's earlier comments upon Listerism 
 and the continental testimony to Lister, how- 
 ever, were in a different tone, and took the form 
 of the misplaced humour of vanity. " On n'est 
 jamais prophet^ chez soi," was its aphorism, 
 although untold suffering was being perpetuated 
 in London. The Lancet even threw its own im- 
 potence in judgment as disproving Lister. " It 
 has been very pertinently remarked," said a 
 leader-writer in October, 1875, "that if the 
 special merits of Mr. Lister's plan were really 
 as great 33 they are alleged to be they should 
 at the expiration of eight or ten years have 
 declared themselves with overwhelming force and 
 certainty." One sickens even now to read such 
 an example of silly arrogance, which first by an 
 obstinate stupidity refused to go and see and then 
 with inconceivable vanity argued that because 
 it was not convinced there was therefore little 
 or nothing in the new, wonder-working system. 
 
 Yet not only had there been Lister's triumphal 
 tour in Germany and the astonishing evidence 
 it brought forth, but Lister himself at the British 
 Medical Association's meeting held in Edinburgh 
 in 1875 had used the occasion to give frequent 
 demonstrations of his system and to inculcate 
 care, seriousness, and sincerity. " It were far 
 better that the antiseptic system should not be 
 employed at all, than that it should be used 
 
 264 
 
Further Spread ot the Good Tidings 
 
 imperfectly/' he had declared. " For such 
 attempts not oply end in disappointment, but 
 throw discredit on the system. Some people 
 seem to say^ ' I have tried the thing and failed, 
 and therefore, of course, the system is all non- 
 sense.' I have seen it fail in my own practice, 
 but under such circumstances I have always 
 thought there must have been some mistake on 
 my part, and I have endeavoured to discover 
 where my mistake lay. But that does not seem 
 to be the way in which the matter is viewed by 
 some of our professional brethren." What was 
 the reason of failure and apathy? The treatment 
 and its effects were clear. Did the fault lay with 
 him? " It seems to be a difficult thing for me 
 to write the English language so as to make 
 my meaning intelligible," he added caustically. 
 Yet in spite of the Glasgow, Edinburgh, Copen- 
 hagen, and German evidence, and Lister's pro- 
 tests, the Lancet jubilantly reported that " there 
 is less antiseptic surgery practised in the metro- 
 politan hospitals than ever there was." 
 
 The London surgical world even went so far 
 as to endeavour to set up rival systems of treat- 
 ment, foimded upon principles " quite at variance 
 with those on which Mr. Lister's method is 
 based," according to the Lancet, but in verity, 
 founded on no principle at all. Soap and water 
 in abundance and scrubbing brushes were used, 
 but where was the first principle ? What peculiar 
 cause or condition of disease did the soap and 
 water wash away? To this there should have 
 
 265 
 
Lord Lister 
 
 been an answer, if there had been first principles, 
 but no answer was forthcoming;. Or wounds 
 were left exposed to the air— a method which in 
 clean, small rooms was often very effective, but 
 one that had no first principle, being purely 
 empirical. Compared to the security and range 
 of the antiseptic system these rivals, which the 
 Lancet praised in making out the case against 
 Edinburgh, were quiddling. Lister himself 
 acknowledged that they had had some success, 
 but were in no way comparable to the antiseptic 
 treatment. 
 
 Von Nussbaimi's language was more forcible : 
 " Some one might reply, ' Before Lister's dis- 
 covery people sometimes got well in a wonder- 
 ful manner. Sound country folk endured ampu- 
 tation and healed forthwith. Mr. Spencer Wells 
 has had wonderful results in ovariotomy without 
 following Lister, and Mr. Callender in general 
 surgery.' 
 
 " True, we do not deny it, but closer inves- 
 tigation shows how little there is in this attack. 
 Of what use is it to mankind that one case heals 
 forthwith and the others ma,ke the whole house 
 reek with the stench and become deadly sick. 
 But if one operates after Lister's method, all 
 danger of such results are averted. . . . Against 
 this the opponents of Lister produce Messrs. 
 Spencer Wells and Callender, and yet both 
 gentlemen have themselves supplied the answer. 
 
 " Mr. Callender works in the richest hospital 
 in the world and acknowledges that he uses a 
 
 266 
 
Further Spread of the Good Tidings 
 
 form of antisepsis, though not Lister's . . . 
 Mr. Wells's hospital is like a private house, in 
 the whole building there being only three or 
 four patients .... Moreover, his cases, brought 
 forward by Lister's enemies, really prove the 
 opposite, for Mr. Sims analysed thirty-nine cases 
 of death from Mr. Wells's figures, and foimd 
 that twenty -four of them ha.d died of acute blood- 
 poisoning." 
 
 It was in this hostile state towards the Edin- 
 burgh antisepsis that the London surgeons re- 
 mained until 1877. There were a very few 
 exceptions, notably Mr. Tom Smith, who declared 
 that the general hostility was quite unjustified 
 unless Lister's system was tried in toto and found 
 wanting. He urged a fair trial, and himself set 
 about giving one. The great majority of London 
 surgeons, however, in their vanity set themselves 
 up, as an insuperable barrier between the incal- 
 culable benefits of Listerism and their long- 
 suffering patients. 
 
 A severe comment by Lister upon the inade- 
 quacy of the clinical surgical teaching in London 
 gave an occasion for the scarcely concealed 
 venom to break forth. The Lancet, amongst 
 others, made itself the mouthpiece of the " howl 
 of derision," a term by which one of Lister's 
 devoted followers described this outbreak of the 
 feeling of the London surgical world towards 
 the Edinburgh professor. Mr. Lister was " like 
 a man who in the excitement of enthusiasm raves 
 at the false creations of his heat -oppressed 
 
 267 
 
Lord Lister 
 
 brain",; "he seems to have lost himself in in- 
 fatuation ; " " he so far forgot all the rules of 
 decency and good taste as to contemptuously 
 decline an offer that has never been made to 
 him ; " and finally, this piece of envious be- 
 littling ; "in many quarters Mr. Lister has 
 acquired the reputation of a thoroughly pains- 
 taking surgeon, and has done some practical 
 service to surgery by an insistence upon the 
 importance of cleanliness in the treatment of 
 wounds, although this has been done by the 
 glorification of an idea which is neither original 
 nor universally accepted." 
 
 The offer to which the Lancet referred had 
 actually been made to Lister. It was that of 
 the post of Professor of Surgery at King's College 
 Hospital, rendered vacant by the death of Sir 
 William Fergusson. In the form that it was 
 made it did not permit of Lister giving clinical 
 surgical lectures nor to take his own trained 
 assistants with him. Moreover, King's College 
 Hospital was one of the smallest London hos- 
 pitals, and Edinburgh, by its world-wide fame, 
 gave Lister the largest student field he could 
 obtain. His father, whom he had greatly loved 
 and frequently visited in London, had died in 
 1869, a few months before his father-in-law's 
 death. 
 
 His nearest friends as well as his large 
 private practice were in Edinburgh. The in- 
 ducement to change was in no way great. 
 Lister consequently declined the offer, not con- 
 
 268 
 
Further Spread of the Good Tidings 
 
 temptuously, but with the refined courtesy that 
 graced all his relations with others and made 
 his charm deeply felt by all with whom he came 
 in contact. London sustained " an irreparable 
 loss/' said the British Medical Journal, Lister's 
 chief supporter. 
 
 The sudden outbreak of the hostility of 
 London, demonstrated so fiercely against him, 
 gave him cause to reflect. It called forth a 
 counter-display of devotion on the part of the 
 Edinburgh students, who had heard of the sug- 
 gested change. A petition, signed by upwards 
 of seven hundred students, begged him not to 
 leave Edinburgh. "Your self-devotion to the 
 advance of surgery, and your indomitable 
 energy," it said, " have given us a mental 
 stimulus for good, the effects of which it is 
 impossible to overrate. . . . The welfare of our 
 school is so intimately boimd up with your 
 presence, that its withdrawal must be an irre- 
 parable loss, not only to it, but to all of us, 
 who would have to mourn the loss of a highly, 
 esteemed and greatly beloVed teacher. We are 
 far from disparaging that field to which you 
 may be called ; but we would venture to submit 
 that nowhere will you find a more numerous 
 or devoted band of followers than those wh)o 
 now count it their highest privilege to listen to 
 your teaching." Lister was moved by this touch- 
 ing address, written frorrt the hearts of his 
 students, more than by any other honour that 
 could have been paid to him. But, by showing 
 
 269 
 
Lord Lisjier 
 
 the conversion of Edinburgh, it emphasized the 
 more the larger decision which he was called to 
 face. As a man of the highest genius, he had 
 gifts for the whole world of men. London 
 proved the great stumbling-block to his dis- 
 pensations, being beset with the belittling spirit 
 of spite, which caused the Lancet to refer to 
 the students' petition as " the seductions of 
 flattery." The London medical profession had to 
 be shaken from its apathy and arrogance and 
 to be forced, not only to give the new salvation 
 to its patients, but also to fill worthily, the high 
 place in the eyes of the world which the repu- 
 tation of the great metropolis gave to it. 
 
 Lister wrote to the Governors of King's 
 College Hospital that, in the event of his being 
 given full opportunities for the teaching of 
 clinical surgery, and being allotted separate 
 wards to manage, to which he could appoint 
 his trained Edinburgh house-surgeons, dressers, 
 and nurses, he was now willing to accept the 
 appointment. The terms were, of course, wholly 
 without precedent, but so too was Lister. The 
 Governors yielded, and Lister was made Pro- 
 fessor of Clinical Surgery to King's College 
 Hospital. 
 
 Accordingly, at the end of July, 1877, Lister 
 delivered his last address to his faithful Edin- 
 burgh students. The address has not been pre- 
 served ; a misfortune, for a brief abstract shows 
 that it dealt with the philosophy and ethics of 
 the medical profession, subjects upon which the 
 
 270 
 
Further Spread of the Good Tidings 
 
 words of so great and noble a man as Lister 
 possess an incalculable value. 
 
 ■When his students began to practise, he 
 strongly urged them to keep always in mind 
 that " their profession would always be an exalted 
 profession, perhaps second to none in that 
 respect. It was, on the one hand, fraught with 
 the deepest scientific interest, and, on the other, 
 it was a profession of pure beneficence, and in 
 this respect would vie with the clerical calling. 
 But if a profession of a lofty character, it was 
 also a profession presenting temptations to the 
 degradation and debasement of those who prac- 
 tised it. There were peculiar temptations in it 
 to quackery in one form or another. They 
 would find that their patients would repose 
 unlimited confidence in them ; and being thus 
 implicitly trusted, and having no one to over- 
 look them, they were constantly liable to profess 
 what they did not know, and sometimes to do 
 what their best feelings would tell them ought 
 not to be done." He urged them, therefore, to 
 take up every hospital appointment they could, 
 and by knowledge and practical efficiency to 
 be able to dispose of the temptation to make 
 use of quackery. 
 
 Lister returned to London, his native city, as 
 a combatant. Yet throughout his life his war- 
 fare was directed not against men but against 
 the foes of mankind. Throughout the years in 
 which his doctrine was meeting friend and foe, 
 
 he showed neither temper nor impatience, but an 
 
 271 
 
Lord Lister 
 
 indomitable will and energy, a quiet irony 
 towards his opponents, an invariable courtesy 
 to friend and foe alike. His outward calm' was 
 never ruffled. No man ever conducted a cam- 
 paign with such imperturbable serenity. A 
 humorous poet described his qualities at Edin- 
 burgh in a long poem, of which the following 
 is a selected stanza :— 
 
 " To work out this solution, tooth and nail, 
 
 With skill and labour at it Lister went, 
 Fully determined that he should not fail ; 
 
 And many an hour, and day, and week he spent. 
 Racking his very brains till he grew pale, 
 
 And making many an experiment, 
 Until at last he found — it made him placid — 
 
 The true solution in Carbolic Acid." 
 
 And in like manner the author of " Rab and 
 His Friends " depicted him : " You have only 
 to look at his face to see how uninjured he has 
 been in his walk through life." 
 
 272 
 
CHAPTER XII 
 
 LONDON AND THE FINAL ACCEPTANCE 
 
 " At this time of day it is well-nigh impossible 
 for us to realize the boldness of this appoint- 
 ment," recently wrote an official of King's 
 College as a comment upon Lister's appointment. 
 The London hospital staffs at that date would 
 admit no one from without. Although Lister 
 had been house-surgeon at University College 
 Hospital, his sixteen years in the north had 
 marked him down as a foreigner to the metro- 
 polis. The British Medical Journal, however, 
 used its powerful influence in Lister's favour, 
 and devoted a leading article of welcome to 
 him, who would add " to the glory and greatness 
 of the surgical profession in London." The 
 Lancet, the zealous advocate of Lister's Edin- 
 burgh appointment seven years previously, was 
 now silent. In general the appointment was 
 regarded in the light of a distasteful experiment, 
 which the responsibility of the profession to the 
 public had rendered imperative. Mr. Timothy 
 Holmes, in a letter to the medical papers, ex- 
 pressed the peculiar London view. An experi- 
 ment was to be made. The antiseptic treatment 
 
 273 s 
 
Lord Lister 
 
 was to be thoroughly tested, as it were, for the 
 first time. All the Edinburgh, German, and 
 other evidence was to go by the board. London 
 would decide. Mr. Wood was a fellow -professor 
 with Lister at King's. Mr. Wood, tho-uglh he 
 had spoken well of carbolic, did not practise 
 antisepsis systematically. Messrs. Wood and 
 Lister would have about an equal number of 
 patients. The human deaths in each ward could 
 be counted, and the general conditions compared. 
 The test was a fair one. By it let the antiseptic 
 system stand or fall. 
 
 Lister brought with him from Edinburgh his 
 two house-surgeons, Mr. Watson Cheyne and 
 Dr. John Stewart, two juniors and nurses, who 
 were all trained in the antiseptic system and 
 regarded their chief more than ever as Henley 
 had seen him :— 
 
 " We hold him for another Herakles, 
 Battling with custom, prejudice, disease." 
 
 Dr. Stewart, in a paper read before the 
 Academy of Medicine, Toronto, has given an 
 admirable account of Lister's first London lecture, 
 delivered at King's :— 
 
 "On the afternoon of October i, 1877, 
 Lister delivered his introductory lecture at 
 King's College. I regard it as a memorable 
 historic occasion. The subject of the lecture 
 was bacteriology ; it was perhaps the first 
 on the subject ever given in London, and 
 
 274 
 
London and the Final Acceptance 
 
 as yet the science had not a name. The 
 theme was the action of germs on milk and 
 putrescible fluids, and he told of experiments 
 he had carried on during the summer. 
 
 " Cheyne and I called at his house early in 
 the aiternoon . We f oimd him in his shirt-sleeves, 
 perspiring as usual, busy getting in order the 
 exhibits for his lecture. Mrs. Lister was help- 
 ing, also his nephew, Mr. Godlee, now Presi- 
 dent of the Royal College of Surgeons, who 
 had prepared some very beautiful coloured 
 drawings as illustrations. There was a large 
 number of glasses and tubes, culture tubes we 
 should call them, but that term had not arrive<d, 
 some containing milk which had been acted on 
 by various kinds of germs, and some which had 
 been kept successfully from infection. These 
 stood on plate-glass slabs and were covered 
 by small glass shades . We drove from his house 
 to the lecture-hall in Somerset House. 
 
 " We supported the trays and glasses as care- 
 fully as possible. They had been brought suc- 
 cessfully all the way from Edinburgh, but were 
 now in perilous passages ; there were occasional 
 awkward jolts, and they sometimes rattled ter- 
 ribly. I made some remarks about ' Cassar and 
 his fortunes,' and I well remember his gentle, 
 amused, and somewhat pensive smile. Lister 
 was well received. The spacious lecture-hall 
 was crowded with an audience which contained 
 not only many of the most distinguished 
 physicians and surgeons of London, but some 
 
 27s 
 
Lord Lister 
 
 of the leading scientific mten. ... Of the staff 
 of King's, I recollect with most distinctness 
 the dark, square face and piercing black eyes 
 of one of his surgical colleagues. Professor John 
 •Wood, who we supposed was hostile to Lister and 
 resented his appointment to the chair to which he 
 himself had looked forward ; and the benign in- 
 tellectual face and silver hair of Dr. George John- 
 son, the most distinguished pjiysician on the 
 staff, who was one of those who had been active 
 in securing Lister's appointment." 
 
 Lister chose his subject because of its in- 
 clusiveness. The causes of disease, which he 
 had proved, covered a far wider field than that 
 of surgery alone. It covered in all probability, 
 as Lister said, all so-called infectious and com- 
 tagious diseases, and therefore was of equal 
 importance to the physician. So also was it 
 vital to the obstetrician, accounting for those 
 peculiar fevers of childbirth which proved so 
 baffling and so fatal. To the surgeon its im- 
 portance was supreme. The address itself con- 
 tained the matter and arguments with which 
 Lister's Edinburgh hearers were familiar. It 
 was couched in simple and restrained language, 
 that could give no offence to feelings which 
 Lister knew were already sensitive. Lister 
 allowed himself no oratorical display nor any 
 reference to his or his disciples' successes. With 
 careful reasoning he laid before his audience 
 the basis of the germ theory, and concluded his 
 lecture with these palliative words : " And thus 
 
 276 
 
London and the Final Acceptance 
 
 I believe that we have taken one sure step, in 
 the way of removing this important but most 
 difficult question from the region of vague specu- 
 lation and loose statement into the domain of 
 precise and definite knowledge." 
 
 The address was followed in the evening by 
 a dinner given to welcome the new professor. 
 Many of Lister's friends were present and his 
 future colleagues. The Principal delivered an 
 address of welcome and Lister replied. 
 
 " This was a brilliant and most hopeful begin- 
 ning," said Dr. Stewart, "of what we regarded 
 as a campaign in the enemy's country. But 
 whatever Lister's own thought may have been, 
 the next few weeks were to us of his staff the 
 abomination of desolation. 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. 
 
 " We four unhappy men wandered about, now 
 in the wards of King's, now through older an(d 
 more famous hospitals, and wondered why men 
 did not open their eyes. In these wards the 
 air was heavy with the odour of suppuration, 
 the shining eye and flushed cheek spoke elo- 
 quently of surgical fever. We would show them 
 how things should be done I But how? We 
 had no patients ! We thought of the crowded 
 hours of glorious work in Edinburgh, where 
 Lister had half a dozen ward's and sixty to 
 seventy patients, and groaned over two wards 
 
 277 
 
Lord Lister 
 
 with capacity for a couple of dozen, but only 
 empty beds. We remembered the enthusiasm 
 about the introductory lecture of a session in 
 Edinburgh, when the theatre would be crowded 
 with five hundred eager listeners, and our hearts 
 were chilled by the listless air of the twelve 
 or twenty students who lounged into lecture at 
 King's. And when the patients did come they 
 were curiously unfit to demonstrate the advan- 
 tages of the new system." 
 
 Lister himself felt this indifference as keenly 
 as his assistants. He said he used to hang his 
 head when driving down to King's at the thought 
 of devoting himself to the convincing of a hand- 
 ful of apathetic students of the value of a system 
 which he believed was revolutionizing the world's 
 surgery. 
 
 But in a month an opportunity presented itself. 
 A man who had broken his knee-cap was ad- 
 mitted to Lister's wards. In such a case, in 
 spite of the weak knee that commonly results 
 if the leg is merely splinted, no London surgeon 
 would have thought of cutting down upon the 
 split bone and wiring the pieces together. The 
 danger of infecting the knee-joint would have 
 made such a procedure appear homicidal. Lister 
 fearlessly cut down upon the split bone and 
 joined the two pieces together with silver wire, 
 a valuable operation he introduced into surgery. 
 A distinguished London surgeon, hearing of this 
 operation, said to his students : " When this poor 
 fellow dies, some one ought to proceed against 
 
 278 
 
London and the Final Acceptance 
 
 that man for malpraxis." But of course that 
 man's malpraxis did not lead to death, but to 
 the patient's recovery with the injured knee as 
 strong as the sound one. Soon after this, a 
 patient with an enormous malignant tumour of 
 the thigh was sent to Lister. The patient had 
 been abandoned by other surgeons. It was a 
 test case. Lister removed the cancerous limb. 
 The members of the staff and students visiting 
 this interesting patient were astonished to find 
 him in a day or two sitting up in bed and 
 reading the paper, being free from pain and 
 free from fever. Mr. John Wood, Lister's 
 fellow-professor, was one of the witnesses of 
 this case. He at once abandoned the test which 
 Mr. Timothy Holmes had proposed, of com- 
 paring the results of the two professors. He 
 was generous enough to disclaim any kind of 
 rivalry, and invited Lister to teach him the 
 antiseptic method. Accordingly a patient with 
 a goitre was set aside in a special ward. Wood 
 operated. Lister assisted and supervised the anti- 
 sepsis, the surgeons of King's and many other 
 hospitals crowded in to see. The result was 
 eagerly watched. The dreaded suppuration never 
 appeared. The woimd healed perfectly. From 
 that time onwards the surgeons of King's were 
 convinced, and John Wood, who was to have 
 been Lister's rival in the test, became his friend 
 and follower. 
 
 The most philosophic and famous of London's 
 
 surgeons at the time was Sir James Paget. He 
 
 279 
 
Lord Lister 
 
 took an early opportunity of personally wit- 
 nessing Lister's work. A case soon occurred, 
 which showed the opinion he had formed. A 
 young lady of good family suffered from a large 
 tumour of the shoulder-blade, which caused grave 
 disfigurement. Sir Prescott Hewitt, the Presi- 
 dent of the Royal College of Surgeons, was 
 called in, but refused to incur the risk of the 
 large open wound that the operation demanded. 
 Sir James Paget was summoned. He also refused 
 to operate, but advised the girl's parents to 
 send for Lister. Lister operated at her home, 
 for with his method an elaborate operating 
 theatre is rendered unnecessary. Sir Prescott 
 Hewitt and Sir James Paget were present. In 
 a few minutes the tumour was removed and the 
 operation at an end. The recovery was com- 
 plete and without fever or pain. 
 
 Against such cases it was useless to argue. 
 The attitude of the profession to Lister from 
 now onwards becomes a more pleasant one to 
 record. The great number of us are unable to 
 appreciate the thought of genius, and if we 
 criticize we fall into grievous errors. It is not 
 until it has filtered down to us in practical results 
 that we are able to appreciate it. But when 
 convinced by practical success, then at least we 
 hasten to repair our error of judgment by a loyal 
 acknowledgment of the great gift. Then at last 
 our attitude is a becoming one. We appear in 
 our rightful place as faithful disciples instead 
 of inept judges. From the time that Lister came 
 
 280 
 
London and the Final Acceptance 
 
 to London practising surgeons began rapidly to 
 fall into their proper places. 
 
 Indeed, there was already a very definite stir 
 of new life in the medical profession. In 1874 
 Mr. Erichsen stated " that surgery in its 
 mechanical and manipulative processes, in its 
 art, in fact, is approaching, if it has not already 
 attained to, something like finality of perfection." 
 But he had not reckoned with the discoveries 
 of his quondam house-surgeon, Mr. Erichsen 
 believed that the abdomen, the brain, and the 
 chest would be for ever shut from the intrusions 
 of a wise and humane surgeon. But some three 
 years after the above words were written the 
 new surgery was already doing such operations. 
 The extirpation of ovarian cysts, which if left 
 were fatal to the unfortunate woman who suffered 
 from them, had been undertaken only as an 
 operation of desperation, yet from sixty to eighty 
 out of every hundred patients died. Mr. Keith 
 and Mr. Spencer Wells alone had shown better 
 results, and Mr. Keith was one of the first to 
 trust to Lister's methods. But in 1878 from 
 many side^ excellent results were reported. Pro- 
 fessor Schroder, of Berlin, reported fifty cases 
 with only four deaths, two of which were due 
 to cancer, and therefore unavoidable. Others 
 also recorded like results, and a controversy arose 
 as to which surgeon could most justly claim to 
 be the first to undertake an antiseptic ovariotomy. 
 
 Daring operations upon bones for knock-knee, 
 
 club-foot, and other deformities were devised 
 
 281 
 
Lord Lister 
 
 and carried out with success. New operations 
 in other departments of surgery were devised and 
 executed. 
 
 As might be expected, the countries which 
 took the lead in antisepsis took the lead also 
 in these new operations. Scotch and German 
 surgeons were chiefly prominent. Mr. MacEwen, 
 of Glasgow, was in the van in setting deformi- 
 ties straight. Drs. von Nussbaum and Schroder 
 brought forward unprecedented statistics in 
 ovariotomy ; but Mr. Spencer Wells, of London, 
 having adopted Listerism, worked with equal 
 security and brilliancy. Dr. Matthews Duncan, 
 Lister's colleague at Edinburgh, though now in 
 London, Drs. Richter, Bischoflf, Fritzsch, and 
 many others in Germany came forward to show 
 the extraordinary improvement Listerism had 
 effected in childbirth in maternity hospitals and 
 also in private practice. Dr. Grafe was eulogistic 
 of the added power it gave to the eye surgeon. 
 Von Volkmann reaped more success and dared 
 bolder operations. Mr. Annandale, Lister's suc- 
 cessor at Edinburgh, proved the safety of anti- 
 septic exploratory incisions to aid diagnosis in 
 doubtful cases of tumour. Mr. Barnes, of St. 
 George's Hospital, showed the safety that 
 Listerism gave to post-mortem operations, and 
 its use in preventing the spread of scarlet fever 
 and diphtheria beyond the sick-room. 
 
 The year 1879 may be called the decisive one 
 in the history of Listerism. 
 
 It opened with the rise of an opponent, who 
 
 282 
 
London and the Final Acceptance 
 
 would have been formidable had he had a strong 
 case upon his side. This was Mr. William 
 Savory, who by an assertive dogmatism and 
 capacity had earned for himself an unequalled 
 reputation as a teacher of surgery. " He spoke 
 as a great authority, delivering judgment on the 
 problems of surgery." In this particular year 
 he was chosen to deliver the annual address in 
 surgery, and he took the opportunity of saying 
 that whereas he believed in antisepsis and had 
 a method of his own, he did not see Mr. Lister's 
 method should " supersede all other methods in 
 the practice of surgery." But Mr. Savory only 
 won favour from the Lancet, which delivered one 
 more attack upon Lister before its compulsory 
 capitulation, and from Mr, Lawson Tait. Mr. 
 Tait was a capable but eccentric man, who took 
 especial delight in upholding a falling cause. 
 With regard to Listerism he made the unique 
 boast that " in my experience it was an almost 
 uniform result that wounds dressed' after Lister's 
 method suppurated, and in many cases sloughed," 
 results so eccentric that he was gently accused 
 of not understanding the treatment. To this he 
 replied : " My answer is that if the proper use 
 of the dressing was above my intelligence it was 
 useless for general application," a rickety 
 syllogism' upon which to base an opposition 
 to a simple creed that had such powerful evidence 
 to support it. 
 
 Mr. Savory and other opponents of Lister, 
 
 finding that they could not disparage individual 
 
 283 
 
Lord Lister 
 
 cases, began to demand from him the statistics 
 of his resuhs. But Lister, with his usual clear- 
 sightedness, had not the same faith in conversion 
 by figures as he had by personal witness and 
 experience. He had, he said, given his general 
 results of Glasgow and Edinburgh in his papers 
 on the Salubrity of Hospitals, but had not 
 occupied himself with statistical details. " The 
 truth is life is short," he said, " and that when 
 every day begins one has to consider what is the 
 occupation which is most likely to be valuable, 
 and I have felt that there was every day some- 
 thing more congenial and, 1 hoped, more profit- 
 able to do than to compile statistics." Lister, 
 in fact, betrayed that distrust of statistical proof 
 of human truths, which is„ I believe, chiaracteristic 
 of all the greatest — that is to say, the most 
 directly human— men of genius, who deal with 
 the life and the world as the field of personality 
 and vitality, and not as a place to be accounted 
 for by sterile ciphers. 
 
 Mr. Watson Cheyne, when surgical registrar 
 at King's, relieved him of the distasteful labour, 
 and published all Lister's results for a period of 
 nine years. " The result shown," said the British 
 Medical Journal, "is so marvellous a triumph 
 over accidents known to be inseparable from a 
 series of such operations till Lister robbed them 
 of their danger, that they require no corament." 
 
 Nevertheless, the publication of these successes 
 
 drew forth the last and bitterest attack against 
 
 Lister. In this case the envy that prompted it 
 
 284 
 
London and the Final Acceptance 
 
 could not be concealed. The attacker was Mr. 
 Spence, who had been Lister's fellow-professor 
 of surgery at Edinburgh. Mr. Spence was a 
 skilful practical surgeon, and under ordinary 
 circumstances he would have taken Mr. Syme's 
 place as the sustainer of Edinburgh's surgical 
 repute. But his name and fame had been wholly 
 eclipsed by the European reputation of his junior 
 colleague. The visitors who came to Edinburgh 
 thronged Lister's wards, but left those of Mr. 
 Spence, who had adopted a modified antisepsis, 
 scarcely visited. The latter began his attack 
 by a disclaimer of any feeling of envy or un- 
 charitableness, the usual disclaimer that betrays 
 the consciousness of the thing disclaimed. He 
 then launched out into an attack of considerable 
 personal bitterness. 
 
 Lister replied at length with his usual restraint, 
 tempered by irony : — 
 
 " Mr. Spence's article consists of two 
 elements ; one tending to disparage my character 
 as a surgeon, the other calculated to diminish 
 the effect of the statistics which I lately adduced 
 in favour of antiseptic surgery. The former of 
 these elements I shall take leave to dismiss with- 
 out further notice than the remark that, as Mr. 
 Spence never did me the honour to witness the 
 practice which he criticizes, so that his know- 
 ledge of it, beyond my brief descriptions of the 
 cases, must have been derived entirely from 
 hearsay, the exercise of a little charity towards 
 a late colleague might have induced him, in every 
 
 28s 
 
Lord Lister 
 
 one of the points to which he refers, to accord 
 a more generous and at the same time a more 
 just interpretation. 
 
 "But," he continued, with deUghtful irony, 
 " in direct proportion as Mr. Spence succeeds 
 in persuading the readers of thfe Journal of his 
 own superiority and of my inferiority as a 
 surgeon, must his argument tell in favour of 
 antiseptic surgery ; for if, in spite of such dis- 
 advantages, I am enabled, by the application of 
 a new principle, to obtain results superior to his, 
 the fact must speak volumes in favour of the 
 principle." 
 
 Lister had little difficulty in maintaining his 
 position against Mr. Spence. But the matter 
 did not end, for Mr. Spence replied both to Lister 
 and Mr. Cheyne in such a manner that the editor 
 of the British Medical Journal struck out many 
 " irritating and acrimonious personal remarks," 
 and declared that " Mr. Spence's remarks with 
 regard to Mr. Cheyne's contribution are scarcely 
 worthy of so eminent a surgeon." Conse- 
 quently he took it upon himself to close the 
 discussion . 
 
 The decisive character of 1879 was evidenced 
 by far more positive evidence than was the fate 
 of these last attacks upon Lister. 
 
 The International Congress of Medical Science 
 held its triennial meeting this year at Amster- 
 dam. Five hundred medical men from all the 
 countries of Europe met there, amongst them 
 Lister, who was to deliver an addtess. The occa- 
 
 286 
 
London and the Final Acceptance 
 
 sion was one, therefore, upon which a public 
 record of the continental feeling towards Lister 
 and his work could suitably be given. What that 
 feeling was is shown by the following account 
 in the British Medical Jowrnal: — 
 
 " Professor Lister was received by the whole 
 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 Frendh] the 
 whole assembly rose to their feet ; and, with 
 deafening and repeated rounds of cheers, waving 
 of hats and handkerchiefs, hailed the dis- 
 tinguished Professor of King's College with 
 acclamations renewed minute after minute, and 
 time after time, as his name was again and again 
 shouted forth by some grateful and enthusiastic 
 acolyte. This remarkable scene — unprecedented, 
 we imagine, in the history of medical science — 
 continued for some minutes, until Professor 
 Donders, the President, advancing with the dis- 
 tinctive grace and dignity for which he is remark- 
 able, and taking Professor Lister by the hand, 
 as he stood overwhelmed by this magnificent 
 ovation, obtained a moment's silence, and, 
 addressing him, said : ' Professor Lister, it is 
 not only our admiration which we offer to you ; 
 it is our gratitude, and that of the naitions to 
 which we belong.' " 
 
 For what a vision of benefits bestowed could 
 be seen by this quiet, grave man beyond the 
 turbulence of waving handkerchiefs and out- 
 
 287 
 
Lord Lister 
 
 stretched hands, and the ebullience of a con- 
 tinent's enthusiasm. He saw wards, with their 
 trim rows of beds, in which patients lay,, 
 bandaged or splinted but otherwise with cheer- 
 ful faces of hope or peaceful faces free from 
 the awful ravages of disease. No longer were 
 the beds filled with suffering humanity, beaten 
 down by pain and noisomeness that no power 
 or skill of the charitable heart could avert. No 
 longer did he note the feverish glitter of a rest- 
 less eye seeking for help ; the vivid patch upon 
 the cheek, which betrayed the burning touch of 
 a messenger of death; the black, encrusted lips 
 through which the foul breath of a polluted body 
 came in short gasps ; the pinched face, from 
 which fever had sucked forth all the juices and 
 tissues of life ; the terrible insanity known as 
 euphoria, in which a patient on the verge of 
 death is cheated by some horrible phantasy of 
 restored health, and, trembling and feeble, makes 
 the last hopeless efforts to creep from the bed 
 in order to assure the doctor that all is well ; 
 or the ward-screen which surrounded the 
 shrivelled corpse of yet another victim of 
 man's misguided charity. No longer did he see 
 in the surgical wards traps that concealed their 
 deadliness behind the fair front of kindliness, 
 nor in the maternity wards places where many 
 a woman paid for the joy of motherhood with 
 death or a lifelong tribute of pain. And when 
 his vision ranged further afield he saw war robbed 
 of its greatest horrors, the gnawing gangrene 
 
 288 
 
London and the Final Acceptance 
 
 and the burning pygemia which destroy the 
 wounded after the enthusiasm of battle has 
 passed; he saw in private houses a safety, 
 that had previously been unknown ; he saw 
 surgery armed with security venturing into new 
 fields of beneficence ; he saw hygiene, based 
 upon his principles, take from crowded cities the 
 horrors of massed squalidity ; he saw the factory 
 system, which had shown itself so baleful in 
 its influence upon the health and physique of 
 men and women, controlled and cleansed by men 
 trained in his teaching ; he saw charity every- 
 where changed from an impulse of dangerous 
 ineptitude to one of armed understanding ; he 
 saw the spread of the power he had given to 
 mankind to more distant lands than those whose 
 representatives greeted him ; he saw not a 
 hundred nor a thousand, but hundreds of 
 thousands of faces infused with renewed 
 health and happiness as the result of his 
 unequalled gifts. What a vision for a man to 
 see beyond the waving handkerchiefs and hats ! 
 How rightly had the poet proclaimed him 
 " another Herakles," for it was he who had 
 cleansed the Augean stables of the world. 
 
 After the reception at Amsterdam the tale of 
 London's acceptance of Lister is subdued and 
 English in its lack of outward emotion. It was 
 generally felt that a decisive attitude must be 
 taken. A general discussion upon antiseptic 
 surgery by the leading London surgeons was 
 arranged to take place at St. Thomas's Hospital. 
 
 289 T 
 
Lord Lister 
 
 The notable address of the meeting, besides 
 Lister's, was that of Mr. William MacCormac, 
 who had come to live in London. He was one 
 of Lister's first followers, and now spoke over- 
 whelmingly in favour of the antiseptic system. 
 Messrs. Spencer Wells, John Wood, Jonathan 
 'Hutchinson, Thomas Smith, and Knowsley 
 Thornton also expressed themselves convinced 
 of Lister's methods and theory. Sir James Paget, 
 who had been late in adopting Listerism, ex- 
 pressed in fine language the feeling of many 
 a laggard surgeon. " I can compare my experi- 
 ence at St. Bartholomew's Hospital with one of 
 my colleagues, Mr. Smith, and it makes me look 
 back to that part of my life with remorse, and 
 I may say that either through ignorance or 
 inattention I had a mortality of which he could 
 justly say he would be utterly ashamed. He 
 has, during all these operations, used antiseptic 
 treatment thoroughly ; and his success has been 
 so great, in contrast with my failures, that I 
 cannot for a moment doubt its value." 
 
 The meeting finally showed the success of 
 Lister's decision to come and force London 
 surgeons to be the dispensers of the benefits of 
 the antiseptic system. In two years the con- 
 version had been eflfected. It was not without 
 reason that Dr. Ernest Hart, the editor of the 
 British Medical Journal, whose advocacy of 
 Lister had been so potent for good, summed up 
 the results of this meeting in the words : " We 
 heartily congratulate ourselves and the profes- 
 
 290 
 
London and the Final Acceptance 
 
 sion that Mr. Lister's cx>ming to London has 
 been so speedily followed by a signal triumph 
 of that great principle in surgery, which had been 
 accepted everywhere else almost before it was 
 even listened to in London." 
 
 291 
 
CHAPTER XIII 
 
 SIMPLICITY AND BOLDNESS 
 
 One of the finest combinations of two artistic 
 expressions is, it is generally agreed, the song 
 of the Erlkonig of Goethe and Schubert. The 
 climax of the song lies in the pathos of the falling 
 notes of the last terrified cry of the dying child. 
 Yet Goethe's words are singularly simple : " Der 
 Erlkonig hat mir ein Leid. gethan " — " The 
 Erlking has done me a harm." 
 
 The simplicity of the words are not merely 
 the simplicity of a child. It is not a simplicity 
 of innocence, but one of mastery. Probably no 
 one but a poet of genius could attain a climax 
 of feeling with so simple a line. The temptation 
 of a more ordinary poet at such a time would 
 be to make use of a more apparently striking 
 expression. An English translation I have to 
 hand, for instance, speaks of the child crying 
 out that he had been seized in " an icy grasp." 
 
 Goethe, however, was able to be simple, able 
 in spite of the emotion the words provoked to 
 exhibit the mastery of simplicity and not the 
 servility of the writer, who " abandons " himself 
 to the violence of his feelings. 
 
 292 
 
Simplicity and Boldness 
 
 Such simplicity of mastery is only possible 
 as the complement of a bold faith. Genius is 
 the direct and intimate knowledge of nature, and 
 its highest form: is the direct and intimate know- 
 ledge of human nature. Goethe had such know- 
 ledge, and the proof is that, impossible though 
 the whole story of the Erlkonig is, it is in fact 
 so rooted in the reality of human feeling that 
 again and again men and women have been pro- 
 foundly stirred by it. Goethe knew men's 
 feelings. He knew how powerfully he could 
 provoke them with his poem of the strange 
 mingling of imperious death and the beloved 
 child ; and, knowing this, he knew there would 
 be no need for him at the supreme moment to 
 shriek or shock by the advertisement of exag- 
 geration. Sensationalism is the extreme of weak- 
 ness, and is rendered necessary owing to the 
 total inability of sensational writers to appeal 
 to genuine human emotions. Goethe, on the 
 other hand, boldly trusted to his knowledge of 
 the human heart and dared simplicity — the 
 Erlking has done me a harm. The simplicity 
 founded upon a bold' faith in a direct insight into 
 the human heart proved to be the simplicity of 
 mastery, and such was the resulting power that 
 all have agreed to call the poem a work of 
 genius. 
 
 The same qualities of bold faith in an imme- 
 diate knowledge of nature and of a consequent 
 simplicity of means in obtaining a desired result, 
 I would submit, may always be found in the 
 
 293 
 
Lord Lister 
 
 works of genius, and are indeed distinctive of 
 these works. Doubt, cloaked by exaggeration 
 and confusing means to complexity, denote the 
 works of lesser men. The genius, in fact, by 
 the power and mastery he gains from his direct 
 knowledge of nature makes life, or a part of 
 life, simple. 
 
 The two qualities of simplicity and boldness 
 are certainly very noticeable in the work of 
 Lister. 
 
 The bold faith is shown in his basing himself, 
 not upon the teachings of others but upon hiis 
 own direct observation of nature in action, as 
 evidenced by the pigment cells of a frog's web 
 when injured and when recovering. Further 
 direct observations of the frog's web, the outer 
 coating of a frog's tongue, upon stagnant blood 
 in a living blood-vessel and stagnant blood in 
 contact with dead matter, confirmed his first- 
 hand knowledge of the mystery of vitality. With 
 a bold faith he turned his knowledge upon the 
 question of wounds, discarded previous treat- 
 ments, asked the advice of none, and confidently, 
 on his own initiative and as a young man, proved 
 himself upon living human beings. 
 
 The next quality to follow the bold faith of 
 genius is simplicity of means. 
 
 This chapter, reviewing generally Lister's work 
 and illustrative of his simplicity, it is hoped, will 
 not be without interest to the general reader. 
 Owing to Lister's very simplicity, the technical 
 difficulties which arise in the discussion of many 
 
 294 
 
Simplicity and Boldness 
 
 scientific questions will scarcely arise in this dis- 
 cussion. In addition, the delineation of the 
 nature of Lister's work will, it is trusted, also 
 throw light that is not without value upon the 
 general quality that characterizes the work of 
 the greatest men of genius. 
 
 In the question of wounds, healthy animal 
 vitality itself shows the greatest mastery. When 
 an animal is wounded, and the wound is not 
 mortal, one of two things happens. Either the 
 cut surfaces glue together and the wound heals 
 at once — healing, in the surgical phrase, by first 
 intention — or the gaping wound fills up with 
 blood and serum, which clots and forms a scab, 
 covering and protecting the wound until it has 
 healed. ' 
 
 The means Lister first adopted to promote the 
 healing of wounds was to permit in civilized and 
 injured man the formation of a hard and lasting 
 scab. 
 
 In man, and especially in men in hospitals, this 
 healthy scab did not form as a rule. Before it 
 formed the blood, serum, and tissues, which in 
 animals and also in men have an innate power 
 of resisting the forces of decomposition and form- 
 ing a scab, usually failed to resist and became 
 putrid owing to the action of the germs of 
 decomposition. The natural hard scab rarely 
 formed, its constituents were resolved into putre- 
 fied liquid matter. Lister, by mingling the; blood 
 with carbolic acid, prevented this decomposition 
 from occurring and permitted a healthy scab or 
 
 295 
 
Lord Lister 
 
 crust to form', under which the wound healed. 
 Such a system of treatment was very simple. 
 
 In more serious wounds, however, there is 
 frequently a free flow of blood and serum from 
 the wound. In animals this flow nearly invariably 
 gradually dries up, and then the scab forms. 
 Any excess of discharge that continues then 
 escapes from under the edge of the partly 
 attached scab and collects in the hair or fur of 
 the animal. There it dries, and, as the discharge 
 ceases, firmly seals the scab upon the wound. 
 In civilized man, however, the germs of putre- 
 faction, which cause clotted blood and serum 
 to become putrid liquids, usually, and in hospitals 
 almost invariably, prevented this drying up and 
 formation of a scab. Moreover, by the irritation 
 they produced upon the tissues they promoted the 
 formation and continuation of liquid discharge. 
 
 Lister, to prevent this, determined to follow 
 with exactness the first principles of healthy 
 nature. He first destroyed the germs of putre- 
 faction that had obtained access to the wound, 
 and he then covered the wound with a non- 
 putrescible artificial scab. In short, by devices 
 with carbolic he supplied that peculiar vitality 
 which in wounded animals was capable of resist- 
 ing decomposition and of permitting the natural 
 mode of healing to take place, but which in 
 civilized man was frequently wanting. 
 
 Lister's artificial scab, or dressing, therefore, 
 had not only to possess this non-putrescible 
 character, which carbolic gave it, but also the 
 
 296 
 
Simplicity and Boldness 
 
 three characteristics of a natural scab. Firstly, 
 a natural scab is impermeable to liquid or dirt 
 and forms a complete and unbroken shield to 
 the wound. Secondly, it is flexible and elastic, 
 and does not crack or crumble until the period 
 comes when it is proper for it to fall off. 
 Thirdly, when there is still discharge from the 
 wound it allows this discharge to ooze out under 
 its dependent edge until it ceases. 
 
 Lister's first attempt to manufacture an arti- 
 ficial scab was with the carbolic putty, which 
 has already been mentioned. He spread the 
 putty, made from chalk and carbolic oil, upon 
 thin metal sheets, and placed this dressing, with 
 putty face turned downwards, upon the wound. 
 The metal sheet made this artificial scab im- 
 permeable, and the discharge from the wound 
 passed through the putty and escaped into a 
 cloth wrung out in a solution of carbolic, which 
 covered the whole scab. But this dressing had 
 objections. The putty stuck to the skin and 
 was messy, and the metal sheeting was not nearly 
 pliant enough for general use. The dressing 
 could not be placed over the fold of a joint or 
 anywhere where there was folding movement. 
 
 Lister consequently discarded the metal and 
 spread the putty on stiff calico. He made a 
 plaster of it, in fact, and not one plaster but 
 " various kinds." But he found that the dis- 
 charges soaked into the calico and made it 
 sodden, so that it formed no proper impermeable 
 
 scab at all. 
 
 297 
 
Lord Lister 
 
 Lister abandoned plasters and experimented 
 with forms of carbolized paraffin. One of these 
 " certainly made, under ordinary circumstances, 
 an effective as well as an elegant substitute for 
 the putty." But paraffin wax, though adhering 
 cleanly to the skin, cracks and crumbles when 
 moved. Eor this reason Lister found it unsatis- 
 factory. In places where there was movement 
 the dressing soon lost the character of a scab. 
 
 Lister once more returned to plasters, only 
 to abandon them' again. 'He then devoted 
 his research " to obtain some kind of antiseptic 
 cement." 'He found shfellac the most satisfac- 
 tory material. With carbolic acid and shellac 
 he was able to make " a flexible solid with a 
 certain degree of elasticity," which retained the 
 carbolic well and was not " softened by either 
 a watery or oily fluid." Here, apparently, was 
 a perfect antiseptic scab. But the carbolized 
 shellac had one fault. After a day or two it 
 adhered so firmly to the skin that any discharge 
 still existing could not escape from beneath its 
 edge and remained pent up in the wound. 
 
 To avoid this adhesiveness Lister turned his 
 attention to guttapercha tissue. As was his wont, 
 he went to the first sources of information and 
 paid visits to a guttapercha tissue factory. Dis- 
 satisfied with the sulphur caoutchouc, he got the 
 manager of the North British Rubber Works to 
 prepare some without sulphur and blended with 
 shellac. He found by experiments that this 
 tissue, whilst remaining insoluble in carbolic 
 
 298 
 
Simplicity and Boldness 
 
 acid, absorbed sufficient of the antiseptic into 
 its substance to become itself antiseptic. He 
 spread it out, melted some carbolized shellac, 
 and, whilst the latter was hot, poured it over 
 the tissue. The cooled shellac adhered to the 
 tissue. Lister laid this preparation over the 
 wound with the guttapercha tissue in contact with 
 the wound and skin. The scab so formed was 
 almost j>erfect. The guttapercha tissue was, 
 however, apt to crack and also to separate from 
 the antiseptic lac and allow discharge to fill the 
 space between the two substances. Lister there- 
 upon reversed the process of preparation. 
 Instead of painting the lac upon the gutta- 
 percha tissue he spread the lac upon a soft cloth, 
 and when cool painted its surface with a solution 
 of guttapercha in bisulphide of carbon, " which, 
 rapidly evaporating, leaves a coat of microscopic 
 thinness." This microscopic layer he found was 
 sufficient to take away the adhesiveness of the lac. 
 Lister now had a perfect artificial scab. It 
 was antiseptic ; it was flexible ; it was imper- 
 meable ; and it allowed the discharges to escape 
 from under its edges into the carbolized lint or 
 towel that covered and overlapped it. More- 
 over, this scab had a further advantage. If a 
 woimd was such that no discharge from it was 
 expected and a firmly adherent scab desirable, 
 the thin layer of guttapercha could be rubbed 
 off the shellac, the shellac brushed with carbolic, 
 and its adhesiveness was restored to it. Lister 
 had thus obtained an excellent carbolized 
 
 299 
 
Lord Lister 
 
 adherent or non -adherent scab. His faith in 
 the direct processes of nature he converted into 
 a very simple and practical form. One also sees 
 the infinite capacity, for taking pains, a quality 
 exhibited by many who have not had genius. 
 
 Nevertheless, Lister was not quite content with 
 the shellac and guttapercha. In nature he found 
 that a scab had the capacity of absorbing small 
 quantities of fluid from thfe wound and evapo- 
 rating them off into the air at its outer surface. 
 The lac and guttapercha failed in this quality. 
 They covered over the woxmd arid skin, but when 
 the discharge had ceased to run for a time they 
 had no capacity of drying up the track of it by 
 absorption. Consequently the skin over which 
 the discharge ran became soddfen both from dis- 
 charge and from perspiration. Lister experi- 
 mented, therefore, with absorbent stuffs, and 
 tentatively tried a dressing of oakum. The 
 results were promising and led him to gauze. 
 In the preparation of the g'auze he displayed 
 his usual indomitable patience and perseverance. 
 He experimented in a number of methods. 
 Finally he prepared a mixture of shellac, 
 parafiin, and carbolic. The shellac fixed the 
 carbolic and prevented it volatilizing; ; the paraffin 
 prevented the shellac from' sticking to the skin. 
 The mixture was melted and cheap muslin dipped 
 into it and wrung out whilst hot. The fibres 
 of the gauze, impregnated with carbolic. Lister 
 found sucked up a fluid such as meat extract 
 and kept it from putrefaction. 
 
 300 
 
Simplicity and Boldness 
 
 The first time that Lister made use of the 
 gauze showed his bold faith in his own prepara- 
 tions and principles. He had been up nearly 
 all night at his house in Charlotte Square, Edin- 
 burgh, putting the last touches to the preparation 
 of the gauze, and, satisfied with his work, he 
 went off to the infirmary in the early morning and 
 made a large amount of gauze btefore his students, 
 explaining to them the meaning of its various 
 constituents and manufacture. With them he 
 then went into the ward and selected a case for 
 dressing, in which failure would have been 
 disastrous. He was prepared forthwith to have 
 his work proved by the severest test. His prin- 
 ciples and anticipatory precautions did not admit 
 of failure. The wound healed swiftly and cleanly 
 with the new dressing. 
 
 Even now Lister was not content. The 
 carbolic of the carbolized gauze was always 
 slightly caustic to the wound. Consequently he 
 entered into another long series of experiments, 
 spread over a space of five years, which were as 
 minute, as ingenious, and as triumphant as the 
 series by which he established the absorbable 
 ligature. As a result he finally produced the 
 bland, double cyanide of mercury and zinc 
 gauze. This is to-day the most perfect anti- 
 septic gauze in existence, and is in universal use 
 wheresoever antiseptic dressings are employed. 
 
 Lister was not yet done. At first he covered 
 this gauze with a thin mackintosh sheet, which 
 formed the impermeable protective shield of the 
 
 301 
 
Lord Lister 
 
 natural scab. But he was not wholly pleased 
 with it, because, unlike the scab, it did not allow 
 small quantities of fluid to pass through it and 
 evaporate. Th6 experiments of Pasteur had 
 shown what an excellent guard dry cotton-wool 
 was, entangling in its fine meshes all dust and 
 microbes. A flask of sterilized animal fluid, if 
 plugged with clean cotton-wool, was preserved 
 against putrefaction. Lister confirmed for him- 
 self these experiments upon the filtering power 
 of cotton -wool, and was also substantiated by 
 some experiments of Professor Tyndall, wht> took 
 a deep interest in the antiseptic system. Tyndall 
 showed how a light-beam or sunbeam let into 
 a dark room was rendered visible by the dust 
 floating in the air. Air that was free of dust 
 remained dark, and in a room in which the dust 
 had been allowed to settle the visible light -beam 
 was not formed. Tyndall arranged a light -beam 
 in a room full of dust. He then took an ordinary 
 pair of hand bellows and lightly plugged the 
 nozzle with cotton -wool. He blew the air from 
 the bellows across the light -beam. Where this 
 air passed complete blackness resulted. The 
 air was filtered free of dust by the cotton-wool 
 and appeared quite black in the beam. 
 
 Fortified by this knowledge. Lister laid cotton- 
 wool impregnated with carbolic over the gauze 
 as a shield against the entry of microbes in place 
 of the mackintosh sheet. Provided the wool was 
 never soaked through to its outermost parts. 
 Lister found this shield thoroughly effective. 
 
 302 
 
Simplicity and Boldness 
 
 The completed dressing now consisted of a 
 layer of double cyanide gauze wrung out in a 
 weak solution of carbolic. Over it were placed 
 a few layers of the dry gauze, and over the 
 gauze and overlapping its edges a mass of the 
 protecting wool. Such was the final form 
 the antiseptic scab took in Lister's hands and 
 the one that is in use to-day. To my mind and 
 to the minds, I suppose, of most medical men, 
 it is impossible to conceive of a more perfect 
 one. The solution of carbolic in the layer next 
 to the wound and skin purifies them both, and 
 in the early stages of the injury, owing to the 
 sedative power of carbolic, takes away the pain. 
 When this duty has been performed the carbolic, 
 being volatile, escapes through the meshes of the 
 gauze and wool and lets the bland antiseptic 
 gauze unaided take its place. Outside the inner 
 layer are the outer layers of gauze, which, if 
 there is free discharge, suck it up and preserve 
 it from putrefaction. When the discharge is 
 slight its fluid evaporates through the gauze and 
 wool and a dry scab of gauze is formed. Out- 
 side, covering and overlapping the gauze, is the 
 further protection of the soft antiseptic wool, 
 which, provided its outermost parts never 
 become wet with discharge, forms a perfectly 
 flexible and impenetrable substitute for the shield 
 of the natural scab. It is, as I have said, im- 
 possible to imagine a work of greater simplicity 
 and perfection. Out of all the vast variety of 
 means and rnaterial Lister's selective power led 
 
 303 
 
Lord Lister 
 
 him to devise a dressing which joins imagina- 
 tion and reahty together and annihilates the 
 further completion of the complete. 
 
 The antiseptic technique which Lister devised 
 for operations eventually reached a simplicity and 
 directness comparable to the artificial scab which 
 he devised for the dressing of wounds. 
 
 There were two means by which germs could 
 reach a wound. They could be transferred by 
 the fingers of the surgeon or dresser, by their 
 instruments, sponges, or from the skin of the 
 patient. The other method of transference was 
 by the air. 
 
 Lister from the first knew of both and directed 
 his measures against both. As regards the 
 former method of transference, Lister and his 
 dressers followed out a scrupulous cleanliness. 
 At first he used to soak his instruments and 
 sponges in carbolic oil, and found this method 
 satisfactory as regards antisepsis. It is true that 
 Professor Koch, the discoverer of the germ of 
 consumption, proved by laboratory experiments 
 that carbolic oil or any antiseptic oil was use- 
 less against microbes. But that which happens 
 in the human body is often very different to 
 that which happens in the laboratory. The 
 laboratory is at the most only suggestive and 
 not the judge of the body, though many scientists 
 are apt to make it so. Lister's experience with 
 the body and carbolic oil differed from Koch's 
 experience with test-tubes and carbolic oil, and he 
 found the oil's antiseptic powers satisfactory. It 
 
 304 
 
Simplicity and Boldness 
 
 was, however, greasy, messy, and made every- 
 thing slippery. Lister was, therefore, glad to 
 change it for a watery solution of carbolic. 
 
 Lister made experiments with the watery 
 solution of carbolic (1-20) as regards its action 
 upon hair, skin, nails, fat, and other living 
 matter, and he foimd that the solution of car- 
 bolic had a peculiarity that rendered it par- 
 ticularly valuable. It parted very readily with 
 its carbolic when it was poured upon organic 
 matter. Living organic substance had, in fact, 
 a definite selective attraction for carbolic, and 
 Lister found that hair and other substances 
 dipped into carbolic 1-20 took up so much car- 
 bolic that they became impregnated with it at 
 a strength of about 1-5. Not only did they 
 take the carbolic readily from the watery solution, 
 but they also retained it well. Lister foimd that 
 the skin of his hands dipped' for half a minute 
 or less into a solution of 1-20 carbolic retained 
 the carbolic with such tenacity as to render his 
 hands non -infective for all the time of an opera- 
 tion. This readiness of watery solution of car- 
 bolic to part with its carbolic was of the greatest 
 use to Lister. " -We shall purify the skin with 
 a strong ( 1-20) watery solution of carbiolic acid," 
 he said before the members of the British Medical 
 Association at Edinburgh in 1875, "which is 
 the best for detergent purposes ; water holding 
 carbolic acid but slightly and very readily giving 
 it up to act upon anything else. Carbolic acid 
 has a remarkable penetrating property. It 
 
 30s u 
 
Lord Lister 
 
 blends with oily substances and animal matter 
 and penetrates the hair and hair follicles, and 
 therefore such a washing as I am now giving 
 will render the skin absolutely pure surgically 
 speaking. This is a very great point." 
 
 Armed with this knowledge, Lister dtevised 
 an operative technique of extraordinary sim- 
 plicity, which he followed with absolute con- 
 fidence for thirty years of o^perative work. He 
 made use of watery solutions of carbolic for 
 cleansing his own hands and the hands of his 
 assistants, the skin of the patient, the instru- 
 ments, sponges, and the wound itself. The fuller 
 account of this technique I will leave to the 
 later pages of this chapter^ when I come to 
 contrast Lister's simplicity with the complicated 
 methods of the very great majority of modern 
 surgeons . 
 
 Against the microbes of the air Lister first 
 guarded his wounds by uncovering them as little 
 as possible and doing what he had to do with 
 the utmost celerity. When the woimd at an 
 operation was bound to be freely exposed, 
 he relied upon free irrigation to destroy 
 any microbes that had fallen upon it from 
 the air. 
 
 The entrance of air had always been regarded 
 by surgeons as of extreme importance in the 
 question of putrefaction. Pasteur's work had 
 destroyed the belief that the oxygen of the air 
 was dangerous, but it had not taken from the 
 air its importance. On the contrary, it had 
 
 306 
 
Simplicity and Boldness 
 
 confirmed it by proving that germs and spores 
 float about in the air of all inhabited places. 
 Lister, therefore, basing himself upon Pasteur's 
 work and his own confirmations of the same, 
 paid serious heed to the danger of infection from 
 the germs of the air. Consequently, when at 
 the suggestion of two Edinburgh students the 
 possible value of a carbolic spray passed through 
 the air was proposed to; him. Lister felt he ought 
 to make a trial of it. A solution of carbolic 
 was to be sprayed upon the dust of the air in 
 the neighbourhood of the operation, as eau-de- 
 Cologne is sprayed through the air upon the 
 face. So Lister adopted it, and he and his 
 assistants worked in air through which passed a 
 fine mist of carbolic. At first the spray apparatus 
 was worked by hand, then by the foot, and 
 finally by steam. 
 
 There seems to be some incompatibility be- 
 tween Lister's character and the adoption of the 
 spray. It is true, as one of his house-surgeons, 
 the present Sir Watson Chejme, said, that he 
 was " very tolerant of the opinions of others 
 and almost painfully conscientious," but such 
 qualities were always controlled by his own bold 
 faith in his own observations of nature and the 
 need of simplicity. In this matter he seems 
 to have been affected by the accumulative force 
 of the widespread, traditional belief in the im- 
 portance of the air, and this belief, supported 
 by Pasteur's work, overcame his natural inde- 
 pendence. He seems, consequently, to have 
 
 307 
 
Lord Lister 
 
 adopted the spray without testing it. He did not 
 conduct a series of cases with the spray and a 
 series without, and note in this way if the spray 
 really lead to more perfect results. Nor did 
 he expose a putrescible but sterilized fluid to 
 the air, through which the spray was constantly 
 made to pass, and thereby see if the spray, really 
 did prevent the germs of the air falling into it 
 in an active condition and causing putrefaction. 
 The consequence was that Lister, a man of great 
 simplicity, became encumbered with a huge spray 
 producer upon a tripod for which he had to 
 have a carriage when going to private operations, 
 and which was speedily dubbed by irreverent 
 students "the donkey engine." 
 
 Nevertheless his character showed itself in a 
 great dislike of the adopted' encvunbrance, and 
 no doubt in so far as it was concerned felt the 
 sting of ridicule, where otherwise ridicule failed 
 to affect him. Nothing had as yet proved to 
 him the spray's necessity, and he did not stand 
 upon the firm ground of decisive results. Con- 
 sequently he did not feel the security against the 
 weapon of ridicule which a man feels when con- 
 vinced of the value of his work. 
 
 His doubt and dislike continued, but he did 
 not feel justified in abandoning the spray until 
 he was assured of its actual uselessness. Never- 
 theless he kept a keen look-out upon all mlatters 
 and facts that might bear upon the question of 
 its necessity. Three years after leaving Edin- 
 burgh his scepticism was very marked. At the 
 
 308 
 
Simplicity and Boldness 
 
 International Medical Congress in 1881 he gave 
 voice— and his voice was then amongst but not yet 
 the weightiest in the world of surgery)— to his 
 scepticism : " The facts seemed to indicate that 
 the putrefaction so apt to occur in wounds not 
 treated antiseptically is due rather to septic 
 matter in a concentrated form, than to septic 
 matter in the diffused condition in which it 
 exists, either in water or in air. They suggest 
 the highly important question. Is the spray 
 necessary?" "The spray," he answered, "is, 
 beyond all question, the least important of our 
 antiseptic means, . . . but if the apparatus for 
 the spray is at my disposal, I for my part, do 
 not as yet dare to abandon it." Six years later, 
 however, he felt convinced that organisms did 
 not exist in the air in a state of virulence making 
 them a danger to exposed tissues, and also that 
 the spray with its diffused mist was unable to 
 destroy the germs of the air. Consequently he 
 abandoned the spray. He found nO' evil results 
 as a consequence of its omission, and therefore 
 in 1890 at the International Medical Congress 
 in Berlin publicly renounced it. "As regards 
 the spray," he said, " I feel ashamed that I 
 should have ever recommended it for the pur- 
 pose of destroying microbes in the air." 
 
 Some have said it was a good thing that 
 Lister introduced and then abandoned the use 
 of the spray, for by so doing he proved the 
 innocuousness of the air. But Lister was not 
 one who needed such clumsy and circuitous 
 
 309 
 
Lord Lister 
 
 methods for his proofs. The work with the 
 spray was, as a fact, the only superfluous work 
 that Lister ever did, and it was the only method 
 he adopted and made his own at the suggestion 
 of others. What is more curious is that he 
 adopted it and proclaimed it without positive 
 proofs of its value. I can only suggest, as 
 an explanation of this strange departure from 
 his usual character, that the tradition of the 
 danger of the air weighed with him with the 
 astonishing power that a tradition continues to 
 exert upon even a great and original man though 
 he has himself rejected it in its accustomed form. 
 It was this, perhaps, that made him accept 
 without proof the fact of the existence in the 
 air of germs able to set up putrefaction in dead 
 organic matter outside the body, as evidence 
 that the air also bore germs in a condition able 
 to set up putrefaction in the organic matter of 
 wounds . 
 
 With the abandonment of the spray, Lister's 
 antiseptic system assumed the simplicity and 
 direct relation to natural observations that was 
 conformable with his character. It consisted of 
 the artificial scab as a dressing and the use of 
 a watery solution of carbolic as the means of 
 his operative antiseptic technique. 
 
 In this general review of the character of 
 Lister's work, we now come to the important 
 question of its relation to the so-called aseptic 
 treatment of wounds, a question which by con- 
 trast throws considerable light upon the qualities 
 
 310 
 
Simplicity and Boldness 
 
 of genius and those of more ordinary, if highly 
 talented, men. 
 
 Lister, in the early years of his work, sought 
 to avoid as far as possible the irritating effect 
 of carbolic upon a raw wound when kept in 
 contact with it. The carbolic, by its powerful 
 effect upon microbes in the wound, slew them, 
 but this strong action upon the living germs 
 was not without some caustic or irritating action 
 upon the living and injured tissues. Lister con- 
 sequently sought to kill the germs in the wound 
 and then to leave the woimd itself covered by 
 some blander substance than carbolic, under 
 which the tissues could rest and recover. Over 
 this bland substance he placed his carbolic guard, 
 consisting of lint or a towel rung out in a solution 
 of carbolic, or at a later date the carbolic wool. 
 Quite early in his work he recognized this ideal 
 of removing the antiseptic or carbolic guard from 
 actual contact with the wound as soon as it was 
 safe to do soi. Thus in a lecture delivered at 
 Edinburgh in 1870, he said: "Of all those 
 who use antiseptics in surgery, I suspect that 
 I apply them least to the wound. After the 
 first dressing, the object which I always aim 
 at is to have the material in contact with thie 
 exposed tissues approximate as closely as possible 
 to the perfectly bland and neutral character of 
 the healthy tissues." 
 
 This principle of keeping the irritating car- 
 bolic at a little distance from' the wound also 
 found its analogy in the natural scab, the under 
 
 3" 
 
Lord Lister 
 
 surface of which is bland and moist, the outer 
 or protecting surface of which is hard and not 
 fitted for contact with delicate tissues. Cleanse 
 the wound thoroughly with solution of carbolic 
 at the first dressing, said Lister, but after that 
 keep the carbolic as much as possible from the 
 wound. The warning was needed, for many 
 surgeons, hearing of the antiseptic treatment and 
 attributing its miraculous powers to carbolic, con- 
 cluded that the more carbolic they used the more 
 efficacious their treatment would be. Acting 
 upon the principle that one cannot have too 
 much of a good thing, they filled large kettles 
 with solution of carbolic and poured it in 
 cataracts upon the wound. Wherever there was 
 pus, or likelihood of pus, they injected syringe- 
 fuls with a freedom that took no account of the 
 irritating effect the continued use of carbolic had 
 upon the living tissues. Lister distinguished 
 himself from them by the faith he showed in 
 the recuperative powers of cleansed nature. 
 They, on their part, trusted to the recuperative 
 powers supposed tOi be consequent upon their 
 busy interference. 
 
 The errors into which these surgeons fell 
 occurred before Lister's work had been freely 
 discussed by the medical profession. The next 
 exaggeration of Listerism, the so-called aseptic 
 treatment of wounds, arose after Lister had 
 published his perfected treatment. 
 
 Lister introduced the bland double cyanide 
 gauze in 1889, and it was from 1890 onwards 
 
 312 
 
Simplicity and Boldness 
 
 that the exaggeration of his principle of keeping 
 the carbolic from the wound after the first 
 cleansing, and a bland substance in contact with 
 it, developed into a new method, or number of 
 methods, which pass under the wrongful and 
 misleading name of the aseptic treatment of 
 wounds . 
 
 This treatment came into vogue ten or more 
 years after Lister left Edinburgh, and has now 
 largely superseded' Lister's methods hoih in hos- 
 pital and general practice. It is said to be an 
 improvement and a step in progress, but when 
 more ordinary men claim to improve upon the 
 system and practice of the greatest genius surgery 
 has ever knoAvn, one is warranted, perhaps, in' 
 being suspicious. And a little investigation 
 shows that whereas surgeons in the early days of 
 antisepsis m^ade a fetish of cart)Olic, so in these 
 latter days men of necessarily inferior calibre 
 to Lister have exaggerated his principle of keep- 
 ing irritating antiseptics as much as possible from 
 the wound to a fetish, and even claim thereby to 
 have superseded Lister's method. In such a 
 criticism one runs the risk of being accused of a 
 disbelief in progress, and I must confess that 
 when progress follows upon the work of one of 
 the world's great men, my anticipation is that it 
 will be progress downhill. In this particular 
 instance there can be little doubt that the progress 
 in the treatment of wounds since the perfection 
 of the antiseptic system, in elaboration, com- 
 plexity, expense, and decreased safety, has been 
 of a downward character. 
 
 313 
 
Lord Lister 
 
 The difference between Lister and these " un- 
 faithful followers," as Lucas Champonni^re, the 
 famous Erench surgeon, has called the devotees 
 of the aseptic treatment, affords an admirable 
 contrasting picture of the bold faith in nature 
 and the simplicity, that distinguishes the work of 
 genius with the elaborate character and lack of 
 resemblance toi nature that characterize the 
 work originated by, ordinary men. It also illus- 
 trates the wrong way of making use of and 
 showing homage to genius. 
 
 Lister's principle was to render the wound, the 
 neighbouring skin, his own hands, and his instru- 
 ments germ-free by means oif an antiseptic, his 
 favourite being carbolic. To denote the germ-free 
 condition he chose the word " aseptic," from' the 
 Greek a, negative, and a-'qijio), I ttiake putrid, 
 a word which, it Was later pointed out, 
 Hippocrates himself had used. After making 
 the wound aseptic with carbolic. Lister kept it so 
 by placing over it an artificial non -putrefying 
 scab, choosing for contact with the wound the 
 most bland and non -irritating antiseptic he knew 
 —namely, the double cyanide of mercury and 
 zinc. 
 
 I have already endeavoured to show howi close 
 is the resemblance between Lister's artificial scab 
 and the natural scab . His method of making the 
 wound aseptic also bears a close resemblance 
 to Nature's methods, a resemblance not generally 
 recognized by practical surgeons who lack both 
 the philosophic temperament and training. For 
 
 314 
 
Simplicity and Boldness 
 
 the living tissues and their juices have themselves 
 an antiseptic power, Lister, as one might know, 
 being the first to point this out . They themselves 
 have the power of killing germs or rendering 
 them harmless, for " without it," as Lister per- 
 tinently remarked, " surgery in former days would 
 have been absolutely impossible." Life itself 
 would have been impossible, for the smallest cut, 
 admitting germs against which the tissues had 
 absolutely no resisting power, would necessarily 
 have becomfe the door to general putrefaction. 
 In man, however, and especially man in hos- 
 pitals which bred germs of peculiar virulence, 
 this antiseptic power of the blood serum and 
 tissues was not sufficient to prevent putrefaction 
 occurring. Lister, by the use of carbolic acid, 
 supplied the deficiency. The virulent microbes 
 of hospitals, being constantly defeated, lost their 
 virulence, as all constantly defeated things do, 
 and the peculiar diseases they caused died out. 
 The antiseptic power of the body plus that of 
 a solution of carbolic proved an invincible 
 alliance, the only defect being that the con- 
 centrated and prolonged presence of carbolic 
 irritated thfe tissues it had aided. In the double 
 cyanide gauze Lister found a non -irritating ally, 
 but for the initial work he knew no fluid that 
 excelled carbolic. Had he known of any there 
 is no doubt he would have used it. But what the 
 carbolic did was only what the tissues and the 
 blood also do— namely, it killed the germs or 
 rendered them harmless. The resemblance 
 
 315 
 
Lord Lister 
 
 between it and the natural process of defence 
 is an exact one, and as close as the resemblance 
 between Lister's dressing and the natural scab. 
 
 The practitioners of the so-called aseptic treat- 
 ment, on their part, adopted methods which bear 
 no resemblance to the defensive methods of 
 Nature. Instead of following the antiseptic 
 powers of the body and the defence of the scab, 
 they attempt to create a germ -free world in which 
 to operate and dress wounds. To .attain this 
 ideal they rely upon an extravagant, elaborate, 
 and cumbersome procedure. By this they 
 attempt to boil and so render germ-free all the 
 little world in which the patient, surgeon, and 
 dresser have their being. They use thte antiseptic 
 power of steam and boiling water to overcome 
 the myriads of enemies, some of whom would 
 otherwise find their Way to the wound. The 
 general boiling has to be very thorough, and 
 requires elaborate apparatus and a great expendi- 
 ture of time and substance in order to prevent 
 some microbes slipping into the wound by 
 accident. Then, once there, the unaided anti- 
 septic powers of the body may not be sufficient 
 to deal with them. 
 
 A careful surgeon, devoted to the most modern 
 rather than to the most inspired treatment, will, 
 before operating, boil himself as far as it is 
 humanly possible. Preceding serious operations, 
 ideally always and actually as often as possible, 
 he comes direct from the artificial boiling of a 
 Turkish bath. After scrubbing his hands and 
 
 316 
 
Simplicity and Boldness 
 
 arms with soap and water and a boiled brush, 
 he is robed in boiled garments, pulled out of 
 a boiled case by; a nurse who is wearing boiled 
 gloves. She also fits a boiled cap over his head, 
 a boiled mask over his face, and a boiled bag 
 over his mouth and chin. The room or theatre 
 in which the operation is to be performed is 
 so built and ordered that it can be swilled and 
 steamed, for where boiling is quite impossible 
 there perforcedlyi the antisepsis of chemicals is 
 used instead of that of boiling water. All its 
 corners are rounded, its floor mosaic, nothing 
 touches the smooth walls, there is no lodgment 
 for germ or dust. The dressings are boiled, the 
 dishes boiled, the sponges boiled, the soap and 
 brushes boiled, basins are boiled, bags, gloves, 
 mackintoshes, etc., boiled. The assistants and 
 nurse in charge are also in boiled garments and 
 addenda, and any students or visitors who attend 
 the operation to gain knowledge mteet with the 
 same fate. The skin of the patient in thfe area of 
 the operation is cleansed with the old antiseptics 
 —in wa,ys that are unnecessary complications of 
 Lister's simple method, as will be shown— for 
 as yet no method of boiling or steaming the 
 patient's skin without harm' has been devised. 
 After the operation a boiled dressing is bound 
 over the wound. This dressing, placed over a 
 clean wound that has been closed by, stitqhes, 
 forms, it is true, an efficient and bland covering. 
 In fact. Lister himself was almost certainly the 
 first man to makfe use of such a dressing, some- 
 
 317 
 
Lord Lister 
 
 times when at Edinburgh covering clean, simple 
 wounds with cotton-wool which he had sterilized 
 by heat. It is significant, however, that as a 
 result of his trials, he never publicly, recommended 
 this dressing. The reason for not doing so is 
 clear. In a wound, and especially an open 
 wound, such a dressing forms no hindrance what- 
 ever to putrefaction arising. Hence, in a wound 
 so dressed there is always a risk of it becoming 
 infected from without— at least, until the day of 
 the surgical millennium arises when a boiled 
 patient in a boiled nightshirt will be kept in a 
 boiled bed in a hospital that knows no dust or 
 dirt. 
 
 By this elaborate boiling and steaming the 
 antisep&is, which Lister used as an ally acting 
 in conjunction with the natural powers, is not 
 used in or over the woxmd, but by a com'plicated 
 ritual is spread over the whole peripheral environ- 
 ment, whereby a surgical hospital, its inmates, 
 officers, and equipment are kept as much as 
 possible in a boiled condition. 
 
 The method, though it has arrogated to itself 
 Lister's term of " aseptic," is obviously not a 
 peculiar method apart from an-tisepsis. The 
 properties of steam and boiling water that are 
 used are their antiseptic properties, exactly as 
 it was the antiseptic property of carbolic and 
 other chemicals of which Lister made use. 
 There is no possible justification, except mental 
 confusion, for the change of name to the aseptic 
 treatment of wounds. It is essentially an anti- 
 
 318 
 
Simplicity and Boldness 
 
 septic treatment, the anti- or against-sepsis or 
 putrefaction resulting, as all successful antisepsis 
 does, in a condition of a- or without -sepsis. The 
 treatment only differs from that of Lister in two 
 features— firstly, its far greater complexity, and, 
 secondly, in the uncertainty and defects that 
 always accompany any system that is not based 
 upon a first principle in nature. For there is 
 nothing parallel to this periphteral boiling in 
 nature. There is no part of the world where 
 animals are protected from putrefaction owing 
 to that part of the world being germ-free. Even 
 polar bears have microbes in their skin and fur, 
 and in the torrid zones the same sun which 
 purifies the air also by its warmth encourages 
 the growth or prolificness of microbes. It is by 
 their vitality that animals overcome germs. They 
 are saved from disease^ not by a complete and 
 total absence of germs in their environment but 
 by their practised strength and skill in destroying 
 their enemies. 
 
 The question between Lister and his " unfaith- 
 ful followers " is in no way merely an academic 
 one. There is a distinct danger in this un- 
 faithfulness of lesser men towards Lister's 
 consummate genius. To see with Lister's clarity 
 and to interpret experience with his pene- 
 tration requires Lister's quality. Set a lesser 
 man out upon the same path and by no means 
 can he succeed to the same perfection . A nobler 
 and proper attitude for him is, therefore, to show 
 a faithful adherence to the directions of a man 
 
 319 
 
Lord Lister 
 
 of far greater gifts. A freedom perlmitted to 
 him and to those like to him, a freedom allowing 
 him to " improve and modify " the completeness 
 of genius, is bound to terminate in a medley of 
 confusion. 
 
 Man should confirm the inscrutable decrees of 
 Providence, iwhich pick out one man and endow 
 him with supreme genius, by preserving his 
 incomparable value in a firm tradition . But when 
 an ideal of liberty scouts pre-eminence with its 
 consequent dictatorial authority, and one of pro- 
 gress scoffs at the stability of tradition, then the 
 true value of the insight of genius into the 
 supremely difficult secrets of Nature and a 
 general strengtheining of man's power over 
 Nature is sure to be depreciated and in a great 
 part cancelled. 
 
 If the reader agree with these broad grounds 
 of criticism, he can realize that a distinct danger 
 may have arisen by w*hich the public are likely 
 to lose or actually are losing the inestimable 
 benefits of Lister's creative generosity. And he 
 may, moreover, be disposed to see that this loss 
 is not wholly the faidt of modern medical men, 
 but is also due to an age in which liberty arid 
 progress as ideals have jealously destroyed the 
 equally legitimlate claims of authority and tradi- 
 tion to a place in the human economy. For 
 the wisdom of preserving greatness by tradition 
 cannot be questioned. Indeed, if no such 
 tradition is formed the efforts of greatness 
 become almost as ephemeral as the deeds of 
 
 320 
 
Simplicity and Boldness 
 
 ordinary men, and all life is reduced to a state 
 of empirical mediocrity. 
 
 Howsoever this may be, there can be little 
 doubt that a mfethod that is simple and efficacious 
 is, upon a priori grounds, more certainly the 
 work of a master than one that is complicated. 
 The character of Lister's full operative technique, 
 which he himself pursued for thirty years of 
 operative work of vinparalleled cleanliness, is 
 astonishingly simple compared to the technique 
 of the so-called aseptic surgeons. 
 
 The first step in operative technique is in the 
 rendering of the skin of tlie patient in the region 
 of the operation aseptic or free from infecting 
 germs. Lister tested and imderstood the way 
 in which a watery solution of carbolic parted 
 with its carbolic to skin, grease, and hairs. He 
 therefore washed the area of operation with a 
 solution of carbolic (1-20), and then left it 
 covered with a cloth wrung out in this solution 
 whilst the ordinary preparations for the operation 
 —such as the anaesthetization of the patient— were 
 being made. Other surgeons began twelve to 
 twenty-four hours before the operation, and have 
 devised imposing performances with soaps, 
 ethers, alcohols, turpentines, corrosive sublimate, 
 biniodide of mercury, and many other combina- 
 tions of capriciously favoured solutions and 
 chemicals. 
 
 This they do, although on many occasions, 
 and notably in an addfess at King's College in 
 1893, Lister expressly said: "It is of great 
 
 321 X 
 
Lord Lister 
 
 importance that we should not make things un- 
 necessarily complicated " (i.e., as regards 
 cleansing of instruments). " So also with the 
 purifying of the skin of the patient. It is not 
 needful to apply an antiseptic lotion for hours 
 together, as is sometimes done ; a few minutes' 
 action of the 1-20 carbolic solution is really 
 sufficient. . . . Carbolic acid has a powerful 
 affinity for the epidermis, penetrating deeply into 
 its substance, and it mingles with fatty materials 
 in any proportion. Corrosive sublimate solution, 
 on the other band, cannot be expected to 
 penetrate in the slightest degree into anything 
 greasy ; and therefore, as the skin is greasy, 
 those who use corrosive sublimate require 
 elaborate precautions in the way of cleansing the 
 skin— treating it with oil of turpentine or ether, 
 not to mention soap and water, to remove the 
 grease, which they feel it is essential to get rid 
 of, for the efficient action of the corrosive sub- 
 limate. Now all this is unnecessary care, if you 
 use carbolic lotion. I can testify to this from 
 very ample experience. For my part, I do not 
 even use soap and water. I trust to the carbolic 
 acid, which, by its penetrating power and great 
 affinity for organic substances, purifies the 
 integument as corrosive sublimate cannot." 
 
 The difference between the faithful and un- 
 faithful follower would be best appreciated by 
 actually witnessing their several performances. 
 The faithful follower to cleanse the skin wets 
 the whole operation area with carbolic lotion and 
 
 322 
 
Simplicity and Boldness 
 
 covers it with a cloth wrung out in the same 
 lotion. This simple procedure completes the 
 cleansing. 
 
 A far greater ceremony is conducted by the 
 second. Overnight the nurse or dresser has 
 already begun the performance by shaving the 
 area, if there were hair to shave, and laying 
 antiseptic wrappers upon it. When the patient 
 is lying upon the operating table under chloro- 
 form or ether the surgeon or his assistant removes 
 the wrappers with forceps. A small, wide- 
 necked boiled bottle containing ether is held 
 towards him by a nurse. Into this fluid a boiled 
 sponge or swab held by boiled forceps is dipped. 
 The skin is then sponged with ether. Another 
 small bottle is uncorked and held up, the cere- 
 mony is repeated, and the interested spectator 
 will note that the skin is now yellow. A third 
 bottle is held up, another boiled swab soaked 
 in it, and then the spectator will see that with 
 each sweep of this swab the yellow skin is 
 restored to its natural colour. A fourth bottle 
 is held up, and the visitor may detect the peculiar 
 odour of alcohol and note that the skin first 
 pales and then reddens under its application. The 
 nurse again steps forward, this time holding up 
 a tin from which the surgeon picks a large piece 
 of lint or gamgee tissue, which by its faintly 
 browned appearance may show that it has been 
 baked for a considerable time. This is spread 
 by forceps over the cleansed skin^ to lay there 
 until every one is ready to begin ; the ceremony 
 
 323 
 
Lord Lister 
 
 is at an end, and the visitor, it is to be hopied, 
 duly impressed. He might, in fact, come to 
 the opinion that the unfaithful follower by his 
 greater elaboration was the more careful and 
 trustworthy of the two, unless he always kept 
 before him the value of simplicity ; for men are 
 apt to be impressed by pomp and show, and to 
 mistake these advertising qualities and concoc- 
 tions of vanity for merit. And in show the 
 unfaithful followers of Lister certainly outstrip 
 him, but not in final efficacy, for the purity of 
 wounds which he achieved has certainly never 
 been surpassed, and has only been equalled by 
 some of his most faithful and discerning pupils. 
 
 Lister's method of preparing himself and his 
 assistants for an operation possessed the same 
 simplicity. He took off his coat and put on 
 another or an apron to protect his clothes. He 
 then turned up his sleeves. He washed his hands 
 in soap and water, rinsed off the soap in clean 
 water, and then dipped his hands for some 
 seconds into the solution of carbolic. The skin 
 took up the carbolic and rendered his hands 
 antiseptic even for a long operation without 
 further trouble. 
 
 Lister did not use the nailbrush, which he 
 regarded as superfluous. He did not scrub his 
 hands for so many minutes by the watch nor 
 soak them in several lotions. He did not use 
 boiled gloves, boiled robes, boiled cap, boiled 
 mask, or boiled muzzle. He remained an 
 ordinary human being to the eye of the spectator. 
 
 324 
 
Simplicity and Boldness 
 
 He was not attired like a mummer at a carnival. 
 He never adopted all these " improvements," for 
 the reason that he had faith in his own observa- 
 tions of the power carbolic possessed of render- 
 ing and keeping organic matter aseptic. His 
 faith was justified. The cleanliness of his results, 
 as has been said, has never been surpassed. 
 Year after year went by and never a wound 
 under his charge went wrong. 
 
 It was the saime with regard to the rendering 
 of the instruments aseptic, the same contrast 
 between Lister's simplicity and bold faith and 
 the complexity of the boiling and steaming 
 method. The instruments were always scrubbed 
 with soap and water, dried, and put away after 
 an operation. Immediately before the adminis- 
 tration of the anaesthetic in a new operation they 
 were taken out, put into dishes, and well covered 
 with carbolic solution. " This same 1-20 
 carbolic solution is what we use for purifying 
 our instruments, our hands, and the skin of the 
 patient," said Lister in the address delivered at 
 King's College in 1893. "For the instruments, 
 it is very much more convenient to be able to 
 purify them by a solution like this than to boil 
 them as is sometimes the fashion at present. For 
 private practice it would be a most troublesome 
 thing to boil your instruments." That this 
 method of Lister's is quite as reliable as 
 boiling his own long experience places beyond 
 doubt . 
 
 There have, of course, been protests from the 
 
 325 
 
Lord Lister 
 
 faithful followers at this departure from Lister's 
 masterful simplicity, but the voices raised have 
 been few. Sir Hector Cameron, in the Watsonian 
 lectures of 1907, said that the elaborate com- 
 plexity of modern-day methods compare badly 
 with the simplicity of Lister. They are quite 
 unsuitable for general practice. " Precautions 
 are taken as regards architectural and mechanical 
 arrangements, the amount of skilled assistance 
 required, and the use of gloves, masks, and other 
 accessories, all of which are in their entirety 
 quite incompatible with ordinary practice. 
 Surgery is thus converted into a pursuit which, 
 at least in its ideal manifestation, can only be 
 carried on successfully in a splendidly equipped 
 hospital. . . . The author of antiseptic surgery 
 deplored the complications to which I have re- 
 ferred, which he knew from his experience to 
 be wholly superfluous." 
 
 Dr. Lucas Champonniere, the greatest of 
 French surgeons of to-day, the pioneer of Lister's 
 methods in France, and, like Sir Hector Cameron, 
 Lister's lifelong friend, is more emphatic con- 
 cerning " the unfaithful followers of Lister." 
 " With asepsis," he said in 1902, " the position 
 is much more serious. This surgery is nothing 
 more than laboratory work " (founded on Koch's 
 and others' experiments in test-tubes). " Never 
 before have the architects been more indispen- 
 sable. The least defect in the condition of an 
 operation -room manifests itself by disasters. If 
 the surgeon do not surround himself with im- 
 
 326 
 
Simplicity and Boldness 
 
 practicable precautions — masks, gloves, etc. — thfe 
 safety of the patiait is imperilled. The old 
 surgical world protested against the easy and 
 regular precautions which Lister took. Modern 
 surgeons, instead of moderating those precautions 
 which might be moderated, introduce new and 
 incredible precautions incompatible with regular 
 practice. 
 
 " And yet have they altered the results of 
 surgery? Certainly they have caused it to lose 
 its safety. That which Lister assured — the 
 mathematical safety of surgical work done in 
 accordance with the precautions indicated applic- 
 able under all circumstances, in all places, with 
 all patients, and without lengthy preparation — 
 that security has disappeared. Doubtless the 
 surgeon who devotes so much attention and so 
 large an expenditure to this new task has not 
 gone back to the murderous surgery of thirty 
 years ago, to thfe customary mortality from 
 erysipelas and purulent infection. But look 
 closely to his surgery. You will see how often 
 little accidents occur, how often breaking down 
 of primary union and secondary suppuration are 
 met with. Even examine the statistics and you 
 will see how many disasters occur from time to 
 time, testifying to the inadequacy of their 
 laborious precautions. 
 
 " Let us take, for example, the surgery of 
 the joints, so easily infected during an operation. 
 We shall see that it has been sown with disasters 
 which antisepsis averted." It is the same with 
 
 327 
 
Lord Lister 
 
 other points of surgery which are most sensitive 
 to infection. The buried Ugature is an instance. 
 Even the laity are nowadays only too familiar 
 with the protracted discharge and irritation of 
 a so-called stitch sinus. " Lister's simple direc- 
 tions for preparing it " (the catgut ligature) 
 " afforded an excellent absorbable ligature. Why 
 do surgeons seek ceaselessly for a modification 
 of this ? Why are many of them incapable of 
 making use of this absorbable ligature? It is 
 because they are vmfaithful to the doctrine. 
 
 " It is not on accoimt of my surgical skill that 
 for twenty-five years I have used absorbable 
 catgut without failure, probably oftener than 
 Lister himself has used it. It is due solely to 
 my fidelity to antiseptic principles." 
 
 Dr. Oscar Bloch, Professor Saxtorph's junior 
 colleague and successor in Frederik's Hospital, 
 Copvenhagen, was equally emphatic on the need 
 of faithfulness in an address to his students in 
 1902: "We could show you a whole row of 
 patients who illustrate the same ideal wound 
 course. And we are, as you know, in a hospital 
 that is a hundred and fifty years old, and that 
 lacks all those things which one nowadays calls 
 surgical comforts, and in an operation -room 
 where we are compelled to expose numerous 
 things that can harbour particles of matter. 
 Here are no rounded corners or smooth walls— and 
 then — there is no danger in the portrait hanging 
 on the wall. For it is Lister's portrait I Why 
 such 'good results? Because Lister has intro- 
 
 328 
 
Simplicity and Boldness 
 
 duced the antiseptic system . . . which means 
 precaution added to safety." 
 
 Finally there is the opinion and evidence of 
 Lister himself. " Any material that is merely 
 aseptic," he said in 1893, " such as cotton-wool 
 or gauze sterilized by heat, having nothing in 
 its substance to check in any degree the develop- 
 ment of microbes, will allow the septic evil to 
 spread freely to the wound from the external 
 world if blood or serum happens to penetrate 
 at any point to the exterior. In addition to 
 this fatal objection such a dressing has other 
 disadvantages. The necessary sterilizing appara- 
 tus, though it may be provided at a public institu- 
 tion, cannot well be at the disposal of the private 
 practitioner. And, further, the merely aseptic 
 material, having no power to correct any acci- 
 dental defilement, must require an almost impos- 
 sible degree of care in its manipulation. I have 
 seen this system in operation in very able hands 
 with results by no means satisfactory." 
 
 Lister could secure his results with mathe- 
 matical accuracy. The unfaithful followers have 
 no such security. From the very first their vanity 
 in attempting to improve upon Lister has been 
 pimished by many failures and tragedies that 
 could have been avoided— failures and tragedies 
 whose hardships were visited, not upon them 
 personally but upon their patients. In very able 
 hands all professionally acquainted with surgery, 
 like Lister himself, have seen failures and even 
 tragedies. In less able hands one wrathfully 
 
 329 
 
Lord Lister 
 
 witnesses at this day a harvest of avoidable 
 disasters, mostly partial, some fatal. The very 
 initiation of the " aseptic treatment of wounds " 
 presaged its future. It was foimded upon that 
 combination of mouth admiration of Lister with 
 personal ignorance of his work which often 
 characterizes the " improvers." Professor von 
 Bergmann, of Berlin, was the chief champion 
 of the improved methods, and the authoritative 
 text -book of Dr. Schimmelbusch, the " Aseptic 
 Treatment of Wounds," was founded upon the 
 former's work. Writing even as late as 1893 
 Schimmelbusch paid mouth homage to Lister, 
 calling him the chiefest of stars in the surgical 
 firmament, and at the same time showed his own 
 and his chieftain's crass ignorance of Lister's 
 work and principles by describing Lister's Glas- 
 gow and Edinburgh dressings as ones that com- 
 pletely sealed the wound, adding the superfluous 
 comment obvious to all that such a treatment by 
 damming back secretion in the wound " is futile 
 and even dangerous." Far more futile and 
 dangerous are improvers who are ignorant of 
 the first principles of that which they set them- 
 selves to improve. 
 
 The uncertainty which attaches itself to the 
 aseptic treatment was singularly demonstrated 
 upon a highly critical probational occasion. At 
 the International Medical Congress held in Berlin 
 in 1890 Professor von Bergmann himself re- 
 served for Lister's inspection some cases of 
 removal of the breast as examples of the aseptic 
 
 330 
 
Simplicity and Boldness 
 
 surgery. A number of doctors interested in the 
 rival systems accompanied Lister upon his 
 visit. Von Bergmann, inebriated with results 
 emanating from the laboratory as some Germans 
 are wont to be, and anticipating similar results 
 in the human being, took hold of the edge of 
 the dressing in order to roll back the curtain 
 and reveal the triumph of a method which had 
 superseded that of the great Englishman. It 
 was, indeed, a moment of pride. Everybody 
 stood upon the tiptoe of expectation. Von 
 Bergmann rolled back the dressing from the first 
 case, from the second, from each one in turn, 
 and each case revealed, not a sweet, clean wound, 
 but the old picture of suppuration and decom- 
 position. By some chance each case had become 
 infected, and there was no antiseptic to kill the 
 infection at its birth. Lister, watching with grave 
 interest the results of the improved method, is 
 said to have displayed upon his features the 
 liveliest astonishment. 
 
 So it is at this day. The text-books from 
 which we learn our surgery are full of warnings 
 rather than promises of security to them that 
 loyally follow their instructions. " It should not 
 be lost sight of, however, that wiring of the 
 patella has been followed by suppuration, stiff 
 joint, amputation, and even loss of life ; " 
 " Occasionally a virulent or even fatal infection 
 is started by catgut ; " and suchlike sentences 
 alarm both student and practitioner with the 
 terrible uncertainty of their art. The avoidance 
 
Lord Lister 
 
 of septic disaster — quite apart from surgical skill 
 — instead of being represented as a reward of 
 faithful adherence to Listerism, is shown to the 
 student to be dependent — and even then it is 
 not assured — upon an enormous and expensive 
 equipment of various forms of sterilizers, auto- 
 claves, mosaic floors, tiled walls, sterilized water, 
 air-filterers, highly trained assistants, boiled 
 robes boiling in a short time to rags, boiled 
 gloves soon becoming rotten, boiled instruments 
 soon becoming blunt, architectural rotundities 
 and mechanical specialities, which can only be 
 enjoyed at hospitals by the charity of the 
 public and at nursing homes by the largeness of 
 fees, by quite a limited number of surgeons . The 
 certain benefits of Lister, which could have been 
 spread through the land in cottage as well as 
 palace, have been converted into a ring and a 
 fetish. The student walking the hospital, instead 
 of being taught the beautiful simplicity and 
 mastery of Lister, is like an acolyte instructed 
 in mysteries ; but should he not join the ranks 
 of the peculiar priesthood he eventually finds 
 himself turned out upon the world, dubious and 
 incompetent, because he has not at his beck and 
 call the elaborate paraphernalia of a palatial 
 modern hospital. Surgery, in a word, has been 
 not only rendered unsafe, but it has been made 
 an expensive monopoly of the surgeons who get 
 attached to the public hospitals. Not only does 
 the student and future practitioner suffer gravely 
 from this rapid departure from the simplicity of 
 
 332 
 
Simplicity and Boldness 
 
 Lister^ but the ever-increasing cost to the public 
 is enormous. The need of asepsis, says a writer 
 upon the London Hospital and its construction 
 and outfit, which he much admires, " had led 
 to an enormous expenditure, which becomes a 
 fixed and permanent expenditure." This is no 
 place to enter into a comparative study of this 
 expenditure, which has to be begged from the 
 purses of the benevolent or exacted from those 
 of the ratepayers. I only desire to contrast the 
 masterly simplicity of genius with the pomp and 
 exaggeration of men without the rare and 
 peculiar gift. 
 
 Even Lister's most devoted friends and 
 followers did not become fully imbued with 
 the wonderful simplicity that characterized the 
 master. Upon the occasion of Lister's eightieth 
 birthday, in 1907, it was considered that no 
 memorial could be more appropriate than a 
 collection of his scientific papers. These papers 
 were widely scattered in different periodicals and 
 publications to the misfortune of the profession. 
 The idea was an excellent one. Lister agreed 
 to it, and a committee of his nearest friends and 
 followers was formed. And what was the result ? 
 Something, one hopes, in complete accord with 
 Lister's simplicity and the ubiquity it gave his 
 work. Here was an unequalled chance to 
 arrange all Lister's articles upon inflammation 
 and antisepsis and publish them in a very cheap 
 form, so that every student and practitioner could 
 buy a copy. Translation rights could also have 
 
 333 
 
Lord Lister 
 
 been made easy and inexpensive. There was 
 a chance, in fact, to provide the whole medical 
 world with the New Testament of the New 
 Surgery, for nowhere can one read of the un- 
 folding and perfection of the doctrine better than 
 in the works of the master. 
 
 But alas for the pomp and vanity of man I 
 The edition, which was issued by the Clarendon 
 Press in 1909, was both cumbersome and ex- 
 pensive, " the two handsome volumes " of the 
 reviewers. Their covers and price concealed 
 Lister's characteristics by pretentiousness. The 
 writings, that should have been in the hands of 
 every student and doctor, were formed for the 
 shelves of special libraries. The master was 
 obscured, and students do not learn at the fount. 
 They do not, in fact, learn Listerism at all. They 
 only learn the modern elaborate complexity, 
 which compels them later, when practitioners and 
 attending a surgical case, to discover their own 
 inadequacy and to be compelled, therefore, to 
 send for one of the peculiar ring. 
 
 This happens in all spheres of life and not 
 only in surgery. The small illustration with 
 which this long chapter was begun demonstrates 
 a law that pertains to all human life, whether in 
 science, statesmanship, or, with deeper signifi- 
 cance, religion. It is this, that if the work of 
 genius passes through the hands of other men 
 it invariably becomes soiled. There is only one 
 rightful attitude towards beneficent genius— 
 namely, that of reverent loyalty. Nor should 
 
 334 
 
Simplicity and Boldness 
 
 such loyalty be difficult, for clarity is always a 
 feature of the work and the thought of genius. 
 It was essentially the distinction of Lister. What- 
 soever of his one studies, it is the same. " Trans- 
 parent clearness, simplicity, and directness 
 characterized his thought and speech." Before 
 me I have his signatures in youth, middle years 
 and age. There is no difference between them, 
 but precisely the same qualities of " transparent 
 clearness, simplicity, and directness " characterize 
 them. There is no extravagance, no exaggera- 
 tion. The same qualities distinguished his work, 
 and any exaggeration and extravagance in 
 surgical ritual and expenditure is not his, 
 " He deplored the complications to which I have 
 referred, which he knew from his own experience 
 to be wholly superfluous," said Sir Hector 
 Cameron. " From first to last he worked in 
 old-fashioned hospitals." It was in them, as they 
 were unchanged, that he secured his unparalleled 
 results. 
 
 It will be a very long time before the medical 
 world secures another Lister. It will be a very 
 long time before any gift of such inestimable 
 value, such simplicity, and universality of appli- 
 cation as Lister's antiseptic system is given to 
 the profession, and through it to the world of 
 men. But the profession has soiled the gift with 
 the improvements of vanity. Indeed, so obscured 
 has the gift become, so lost is the security Lister 
 supplied, so much unnecessary sepsis occurs and 
 increases, that recently one of Lister's most dis- 
 
 335 
 
Lord Lister 
 
 tinguished house-surgeons told me in conversa- 
 tion that before long he thought a return to 
 Listerism would be forced upon the profession. 
 One regrets that it had not the wisdom never 
 to leave the antiseptic system. 
 
 The members of the profession have in these 
 latter days, by addresses, degrees, and presenta- 
 tions, frequently acclaimed Lister's excelling 
 greatness. But their acclamations would have 
 been of more genuine worth if they had taken 
 the form of a humbler belief in his incomparable 
 genius and a simpler adherence to his precepts 
 and practice, and if instead of the vanity of 
 change they had displayed the steadfastness of 
 faith. I 
 
 336 
 
CHAPTER XIV 
 HONOURS AND DEATH 
 
 Lister was fifty-two years of age in the year 
 1879, the year in which the final acceptance of 
 the antiseptic system may be dated. From this 
 date onwards, though opposition was not com- 
 pletely at an end, both faithful and unfaithful 
 followers delighted to do him honour. 
 
 Lister had taken for his London residence 
 No. 12, Park Crescent, overlooking the gardens 
 of Regent's Park. At this house and at King's 
 College he continued to pursue his researches and 
 professional work. By research and experiment 
 he perfected and completed the antiseptic treat- 
 ment, as was described in the last chapter. In 
 practical surgery he pursued his operative work 
 both at the hospital and in private practice. In 
 Edinburgh he had had a large private practice, 
 but in London it was never very large, though 
 many picked cases requiring careful antisepsis 
 were sent to him from different parts of the 
 world. At King's also the niunber of beds was 
 also less than at Edinburgh, but sufficient to 
 give him ample practice. 
 
 Lister, of course, did not confine his originality 
 
 337 Y 
 
Lord Lister 
 
 to the antiseptic system. The same original 
 thought which gave birth to and perfected that 
 system was also devoted to every case and 
 patient that came under his care. Consequently 
 one finds a number of original operations and 
 treatments devised by him, which by their sim- 
 plicity and efficacy would have made the repu- 
 tation of any man as a great surgical pioneer. 
 The modern methods of treatment of spinal 
 abscess, diseased joints, cancer of the breast, 
 ununited or badly set fractures, were founded 
 by Lister. In the other great surgical discovery 
 of the last century, that of anaesthesia, he played 
 a considerable part, so that after Sir James 
 Simpson, one would be inclined to name him 
 as the most important British scientist in this 
 great subject. His work formed the subject of 
 the article upon anaesthetics which appeared in 
 Holmes's " System of Surgery "in 1861, and in 
 it Lister laid down the first principles of the 
 administration of chloroform, which still form the 
 basis of the practice. The article is to my mind 
 as remarkable as anything Lister ever wrote. 
 It is so free from redundancy, so direct, and 
 its emphasis upon the concentration of attention 
 upon the respiration, and its description of the 
 reason and right way of pulling out the tongue 
 impart a singular confidence and understanding 
 to the reader. The extraordinary success which 
 Lister and his father-in-law had with chlorofbrm 
 show what a wonderful pair they made in this 
 as in other branches of the art. Lister wrote a 
 
 338 
 
Honours and Death 
 
 fuller article upon anaesthetics in 1882 for 
 Holmes's " System/' which based the practice 
 upon first principles with a lucidity and mastery 
 which no other writer has paralleled. In the 
 same " System/' Lister wrote some fine articles 
 upon amputation^ excision of the wrist, the wiring 
 of the patella, and other technical subjects. 
 
 As a practical surgeon Lister showed the same 
 efficiency. At one time a curious form of attack 
 upon the antiseptic system was for opponents 
 loosely to state that Lister was neither a great 
 operating surgeon nor a great teacher. As a 
 teacher some account of him has already been 
 given. He filled his Edinburgh lecture-hall 
 with eager students. " As a teacher Lister was 
 peerless," said Dr. Stewart. " His earnestness, 
 enthusiasm, and energy were contagious." One 
 does not see how it could well have been other- 
 wise in a man of Lister's character and devotion. 
 
 As an operator, said the same witness. Lister 
 chose to be slow and thorough, rather than 
 " ambitious for a spectacular exhibition to the 
 gallery. . . . Where there was need for speed 
 he was not lacking in this accomplishment of 
 a surgeon. And all who were familiar with 
 his plastic operations must have admired these. 
 The bold, swift, unerring strokes of his incisions, 
 the perfect apposition of the flaps, the provision 
 against tension, gave him better results than I 
 have seen elsewhere. In one thing Lister was a 
 truly great surgeon— he was of infinite resource. 
 No unlooked-for accident, no complication, found 
 
 339 
 
Lord Lister 
 
 him unready." One reads here the qualities of 
 a great leader, surgically displayed. " When 
 rapid manipulation was essential," wrote Mr. 
 Cheatle, " he was quicker and more accurate than 
 any other operator I have seen. . . . One day 
 I was helping Lord Lister in a case of lateral 
 lithotomy. Dr. Hensley timed it. The operation 
 of removing two calculi took thirty-two seconds. 
 The onlookers were soi impressed with the dex- 
 terity he exhibited that they clapped their hands. 
 Lord Lister instantly turned round to^ them and 
 said, " Gentlemen, gentlemen, remember where 
 you are." One is recalled by this story to the 
 skill of James Sjone. 
 
 With hospital and private practice, experi- 
 mental work and teaching. Lister's London days 
 were full, but further demands were made upon 
 his time by the many who desired to do him 
 honour. 
 
 To give a full list of these honours as they fell 
 to him would be tedious. The first honour he 
 received, however, one is glad to record came 
 from his sovereign. Queen Victoria. As a con- 
 sequence of the operation he performed suc- 
 cessfully upon her, she appointed him Surgeon 
 to the Queen in Scotland. After his removal to 
 London he was made Surgeon Extraordinary to 
 Her Majesty, and eventually Sergeant -Surgeon. 
 In 1883 she conferred a baronetcy upon him, 
 and in 1897, the year of her second Jubilee, she 
 raised him to the peerage, he himself wisely pre- 
 serving his own great name in the title of Lord 
 
 340 
 
Honours and Death 
 
 Lister without territorial designation. He took 
 his seat in the House of Lords in the same 
 year, but confined his speeches to debates 
 which had a medical or scientific character. 
 On the occasion of King Edward's corona- 
 tion in 1902, deferred owing to the King's 
 operation for appendicular abscess, Lister was 
 sworn a Privy Councillor. The King showed to 
 Lister upon this occasion the royal tact for which 
 he was so famed. " What pleased me far more 
 than the honour of being made a Privy Coun- 
 cillor," said Lister to his friend, Sir Hector 
 Cameron, " was the fact that when my turn came 
 to step forward and shake hands with the King 
 he said to me, ' Lord Lister, I know well that if 
 it had not been for you and your work I would 
 not have been here to-day.' " 
 
 Lister was frequently invited to the countries of 
 the Continent and undertook the visits described 
 as " almost regal " and " triumphal, not in respect 
 of formal honours only but also of an enthusiasm, 
 almost stupendous." They began with the tour 
 through Germany in 1875, the tale of which 
 has also been told. In 1883 he was inVited 
 to Pesth, and Austria and Hungary did him 
 honour. He met with a tremendous reception. 
 A great banquet was held and a torchlight pro- 
 cession of the students marched past him as he 
 stood surrounded by the most distinguished 
 scientists of the Austrian Empire. The occasion 
 was rendered peculiarly happy by Dr. Duka, 
 a Hungarian physician, who brought to Lister's 
 
 341 
 
Lord Lister 
 
 attention the name of his great but unhappy 
 countryman, Ignatz Philipp Semmelweiss. 
 
 The history and fate of this great and un- 
 happy man excited the liveliest interest in Lister. 
 Here, at the completion of his antiseptic triumph, 
 quite unexpectedly he came across a true but 
 almost forgotten forerunner, who owing to the 
 happy deduction of an original mind fought the 
 unseen enemies of disease with weapons similar 
 to Lister's, though unsupported by the scientific 
 evidence which Pasteur had given to Lister. 
 
 No book upon Lister would be complete, there- 
 fore, without a brief account of the unfortunate 
 physician as it was presented to Lister at Pesth, 
 the story of a fate which must have aroused 
 strange thoughts in the breast of the Englishman 
 who had so recently had the acclamations of 
 his fellow -men ringing in his ears. The contrast 
 between the fates of Semmelweiss and Lister is 
 a striking one, the first enshrouded in an atmo- 
 sphere of darkness and hatred that deepened 
 until it closed about his tragic death, the second 
 enduring through opposition to be heralded with 
 a praise, gratitude, and triumph rarely surpassed. 
 
 Semmelweiss was horn in Hungary in 1 8 1 8, 
 and studied medicine in Pesth and Vienna. He 
 was a man of penetrating observation and judg- 
 ment, piercing quickly through the strata of con- 
 vention and the teachings of other men. As a 
 student he attracted the favour of two famous 
 scientists. Professors Skoda and Rokitansky. 
 With their help and his own ability Semmelweiss 
 
 342 
 
Honours and Death 
 
 was apppinted assistant to Johann Klein, who 
 presided over the misfortunes of the maternity 
 department of the general hospital at Vienna. 
 In this maternity, as in others of the time, the 
 poisoned hand of charity plentifully scattered 
 the seeds of putrid sickness and death. The 
 death-rate in such maternities, as in the surgical 
 wards, mounted with the increasing years of the 
 " wonderful century " as the nineteenth has been 
 named. Vienna began to grow as industrialism 
 increased. The poor began to exchange the 
 accustomed direction of the landed aristocracy, 
 with its tradition of paternal responsibilities, for 
 the impurer atmosphere of cities and the mastery 
 of men who were controlled by no traditions 
 and whose criterion of success lay in their own 
 isolated prosperity and took no heed of the 
 degradation of those whom they employed, men 
 the nature of whose aims proved them to be 
 lacking in the generosity and feeling heart that 
 are essential adjuncts of the capable ruler. The 
 result was, as might be anticipated, the rise of 
 those terrible sufferings which, in a world of 
 retributive justice, visit peoples who neglect to 
 be most careful in their choice of rulers and 
 who allow the ascendancy of the avaricious to 
 the chief positions of authority. 
 
 Amongst the child-bearing women of the poor 
 a condition of things arose of such unparalleled 
 abomination that, had it continued, industrial 
 civilization must have been abandoned as the 
 cardinal blunder of mankind. 
 
 343 
 
Lord Lister 
 
 From the years 1784 to 1823, not one mother 
 in a hundred, deHvered in the Vienna Maternity, 
 died. But as the nineteenth century progressed, 
 in Vienna and in other large cities, an overcroiwd- 
 ing of the hospitals occurred. In all the mater- 
 nities an increase of disease and death resulted. 
 In the Piti^ of Paris in the years 1844-48 the 
 deaths amongst mothers had risen to no less than 
 ten in a hundred, and many women who escaped 
 with their lives went out with the quality of 
 health taken from them for the rest of their 
 years. The General Lying-in Hospital in London 
 showed a still gloomier record, no less than 
 twenty-six out of every hundred mothers suc- 
 cumbing to the administrations of charity. 
 
 When Semmelweiss became Klein's assistant 
 in 1846, he was struck by a contrast, which was 
 almost as great as that between simple and com- 
 pound fractures which so impressed Lister's 
 early days. The Maternity was divided into two 
 departments, one cared for by students and young 
 graduates, and the other by midfwives. In the 
 first division twelve ouf of every hundred mothers 
 died, in the second three out of a hundred, and 
 previous years had shown the same remarkable 
 contrast. 
 
 Semmelweiss added to the freshness of genius 
 that which Lister named the first requisite of a 
 great surgeon, namely, a feeling heart. The 
 suffering he witnessed caused him to suffer too, 
 and spurred him to untiring efforts to avert it. 
 " Therein lay a terrible command to track out 
 
 344 
 
Honours and Death 
 
 the unknown causes with all my power," he said. 
 He dismissed the orthodox theory that the fiery 
 heat of oxygen was the inflamer of the fever 
 of child-bed, and minutely observed every detail 
 and incident of the maternity work afresh. He 
 tested and dismissed conditions of situation, air, 
 season, diet, bad ventilation, and finally came 
 to fix his attention more and more upon the 
 students and doctors themselves. He found that 
 many of them came from the dissecting-room, 
 and often without washing their hands proceeded 
 to examine their unhappy patients. In May, 
 1847, Semmelweiss issued stringent orders to 
 them to wash their hands and to soak them in a 
 solution of chlorinated lime before they sub- 
 mitted the women to examinations . In the month 
 of May, 36 out of the 294 women delivered 
 died, but to Semmelweiss's unspeakable delight 
 from May onwards the death-rate fell rapidly, 
 until it reached the same level as in the midwives' 
 department, namely, three in a hmidred. The 
 improvement, moreover, continued, and in the 
 following year the deaths in his department 
 scarcely exceeded one in a hundred. 
 
 With this remarkable proof Semmelweiss 
 sought to propagate his doctrine. In Vienna 
 many young doctors were convinced and did 
 their best to assist him. Dr. Anefh wrote to 
 Sir James Simpson, and gave that opponent of 
 Lister the opportunity of forestalling his young 
 colleague— an opportunity he rejected in a 
 reply which Dr. Jacob Briicke, Semtn'elweiss's 
 
 345 
 
Lord Lister 
 
 biographer, described as insulting. Dr. Routh 
 lectured before the members of the Royal 
 Medical and Chirurgical Society in London. Dr. 
 Briicke strove to interest Berlin, and Dr. Aneth 
 lectured in Paris. 
 
 But instead of arousing earnest attention, this 
 attempt at proselytizing on the part of some 
 young doctors so offended the elder members 
 of the profession that they treated it either with 
 the indifference of self-satisfied superiority or 
 with the hostility of insulted dignity. One cannot 
 but deplore the reception Lister's obvious truths 
 received in the capital of this land, but the fate 
 of Semmelweiss was far more lamentable. His 
 chief, Johann Klein, blinded by jealousy and 
 vanity, stirred up the authorities and drove 
 Semmelweiss from Vienna in 1849. Professor 
 Skoda came forward in defence of the Hungarian, 
 and, in spite of his repute, was made to suffer 
 seriously for his temerity. Semmelweiss went 
 to Pesth, and there received an appointment to 
 the Maternity. He repeated his triumphant 
 work, and his renewed success added to the 
 venom of his enemies, who pursued him with all 
 manner of persecution. Great man though he 
 was, Semmelweiss was not so great as Lister. 
 He had not the distance of genius, that recog- 
 nition of the gapi; between himself and his 
 fellow-men which enables a genius to pursue 
 his purpose for the welfare of men undeterred 
 by their efforts to prevent him. Semmelweiss 
 allowed his temper to be infiameld by the envy 
 
 346 
 
Honours and Death 
 
 and maliciousness of lesser men than he. The 
 prolonged and constant opppsition of one's 
 fellow-men can only be borne by the strongest 
 mind. Moreover, owing to the freedom that is 
 allotted to each man's personal opinion by the 
 illusion of equality, gienius in these latter days 
 is doomed to be pestered by a swarm of piping 
 Lilliputians. Even though the fight of genius 
 be eventually crowned with success, nevertheless 
 the original ubiquitous hostility, either open or 
 latent, of his fellow-men, his loneliness, his 
 perpetual need of being on his guard, and his 
 inability to converse sincerely with any one with- 
 out first converting him to his first principles, 
 must prove a terrible strain to a really great 
 man. Thus even Lister, though he showed the 
 longevity of his stock, suffered markedly from 
 mental and physical exhaustion in his last years. 
 Semmelweiss had neither Lister's strength nor 
 his success. Every report of an epidemic of 
 puerperal fever, which he knew to be preventable, 
 wrought him to a frenzy. Misunderstood and 
 insulted by having his work dragged down to 
 the plane of personalities and its effect upon 
 the reputations of doctors, and never upon that of 
 philosophy, which regards the fate of man as a 
 whole, his mind gave way, and he died in 1865, 
 the year in which Lister, inheriting his " karma " 
 as a Buddhist might suggest, began his antiseptic 
 studies. His work and almost his name were 
 forgotten until this festival at Pesth was held in 
 Lister's honour. From that time Semmelweiss 
 
 347 
 
Lord Lister 
 
 has been accorded a high place amongst the 
 conquerors of disease. 
 
 Lister's acknowledgment of Pasteur as his pre- 
 decessor was always freely made in his early 
 papers, but it was not until 1874 that he took 
 the opportunity, wheni sending one of his 
 pamphlets to Pasteur, of personally expressing 
 his gratitude and admiration in the following 
 words :— 
 
 " I do not know whether the records of British 
 surgery ever meet your eye. If so, you will 
 have seen from time to time notices of the 
 antiseptic system of treatment, which I have been 
 labouring for the last nine years to bring to 
 perfection . 
 
 " Allow me to take this opportunity to tender 
 you my most cordial thanks for having, by your 
 brilliant researches, demonstrated to me the truth 
 of the germ theory of putrefaction, and thus 
 furnished me with a principle upon wihich alone 
 the antiseptic system can be carried out. Should 
 you at any time visit Edinburgh, it would, I 
 believe, give you sincere gratification to see at 
 our hospital how largely mankind is being bene- 
 fited by your labours. I need hardly add that 
 it would give me the highest gratification to show 
 you how greatly surgery is indebted to you. 
 
 " Forgive the freedom with which a common 
 love of science inspires me, and 
 
 " Believe me, yours very sincerely, 
 
 " Joseph Lister." 
 348 
 
Honours and Death 
 
 It was not until 1881 that Pasteur was able 
 to visit Lister and see his work. In that year 
 he attended the International Medical Congress 
 in London, and was received with great honour 
 by all present. Lister gave a dinner of welcome 
 to him, at which, though himself the host, he 
 proposed the health of his distinguished guest 
 in a speech that greatly affected the emotional 
 Frenchman . 
 
 The mo3t notable occasion upon which these 
 two great men came together was not without 
 occasion for embarrassment to the Englishman. 
 It was at Pasteur's Jubilee, held in Paris in 
 1892, and celebrated with great pomp and 
 fervour. President Carnot, the Presidents of the 
 Senate and Chamber, the Ministers and Am- 
 bassadors, and the delegates of all the great 
 academies of medicine and science throughout 
 Europe were present. Lister represented Great 
 Britain and Ireland, and added his address to 
 others that proclaimed Pasteur's greatness. " Vos 
 recherches," he said, " sur les fermentations ont 
 jet6 un rayon puissant qui a illumine les t^nebres 
 funestes de la chirurgie et a chang^ le traitement 
 des plaies d'une affaire d'empirisme incertain et 
 trop souvent desastreux dans un art scientifique 
 sfirement bienfaisant. Grace a vous la chirurgie 
 a subi une revolution complete qui I'a depouillee 
 de ses terreurs et a ^largi, presque sans limites, 
 son pouvoir efficaoe." Pasteur, already wrought 
 to a pitch of extreme motion, could no longer 
 control himself at these words. Jumping up he 
 
 349 
 
Lord Lister 
 
 hurried to where Lister was seated, and taking 
 the embarrassed surgeon like a child by the hand, 
 led him to the centre of the platform and there 
 embraced him, whilst the spectators thundered 
 their applause and relieved their overfull hearts 
 with sobs and tears. 
 
 Another famous reception was given to Lister 
 at the International Congress of Medicine at 
 Berlin in 1890. Seven thousand people were 
 present, and Virchow was in the chair. Round 
 after round of applause greeted each dis- 
 tinguished man as he ascended the tribune, but 
 suddenly the applause strengthened into a 
 thunderous roar of welcome, which was sustained 
 for several minutes, and the name of Lister rang 
 again and again through the great hall, as Lister 
 himself, surprised and a little timid, stood before 
 the assembly bowing his acknowledgments. 
 
 Lister did not again visit the United States, 
 but in 1897 he attended the meeting of the 
 British Medical Association, which was held 
 at Toronto, and was honoured with enthusiastic 
 acknowledgment by Canadians and Americans 
 alike. 
 
 In Great Britain Lister received the same 
 reverence and gratitude. Universities and 
 academies shofwered dbgrees upon him, and 
 various municipalities conferred upon him the 
 freedoms of their cities. 
 
 The most interesting of these occasions were 
 Lister's visits to his old universities, those of 
 Glasgow and Edinburgh . He visited Glasgow in 
 
 350 
 
Honours and Death 
 
 the spring of 1894, and saw once again the wards 
 which had been the scene of his early triumph. 
 Before many of his old colleagues and pupils, 
 and a number of new faces, he delivered an 
 address. " After the address," wrote the Lancet, 
 " the students became demonstrative again, sang 
 ' Aidd Lang Syne ' (in which Sir Joseph Lister 
 and his old pupils joined' with evident feeling), 
 and finally, outside the University Union, un- 
 yoked the horse from his cab and dragged the 
 conveyance, amidst deafening cheers, from the 
 University to Dr. Hector C. Cameron's house, 
 a distance of over a mile. The distance was 
 covered in a remarkably short space of time, and 
 probably Sir Joseph Lister and his companions 
 in peril were glad when the journey was safely, 
 accomplished. Finally, on the steps of Dr. 
 Cameron's house, a few words were said, ' Auld 
 Lang Syne ' again sung, and the most exciting 
 part of the visit was over. The reception of 
 old pupils and friends, held next day at Dr. 
 Cameron's, was equally enjoyable though alto- 
 gether a quieter function." 
 
 Four years later Lister visited Edinburgh to 
 have the freedom of the city conferred upon him. 
 At the same time the freedom was conferred 
 upon Lord Wolseley. Lister made a witty 
 allusion to his association with the famous soldier 
 in his speech. Both the professions, to which 
 they severally belonged, dealt with great issues 
 upon which depended life and death. The work 
 of the surgeon was, therefore, in some respects, 
 
 35t 
 
Lord Lister 
 
 analogous to that of the soldier, although hap- 
 pily, he dryly added, the analogy was not so 
 close as it once had been. 
 
 Two other occasions, from the many upon 
 which Lister was honoured, may be selected for 
 happy expressions of gratitude. The one was 
 in 1900 at a banquet given to Lord Lister by 
 the leading scientists of Erance. Dr. Lucas 
 Champonni^re, his faithful friend and follower, 
 concluded a speech with these graceful words : 
 " We can remember the miserable condition of 
 surgery and how great was the mortality. 
 Nelaton said that a statue in gold should be 
 raised to the person who was able to prevent 
 what we now know as 'sepsis.' You, sir, have 
 deserved that statue." And Dr. Pinard, the 
 famous women's doctor, at the same banquet 
 ended his speech by saying : " Lord Lister, 
 when we are asked why, you are illustrious, we 
 reply because you have driven back death itself ; 
 because in all you have done you have only 
 caused tears of joy and gratitude." 
 
 The second occasion was at the banquet to 
 Lord Lister given by the Royal Society in 1902. 
 Mr. Bayard, the American Ambassaidor, devoted 
 to Lister a few simple words of singular 
 eloquence : " My Lord," he said, " it is not a 
 profession, it is not a nation, it is humanity itself 
 which with uncovered head salutes you." 
 
 Such were some incidents of the honours 
 shown to Lister. The official list of even the 
 most important is lengthy enough. He was made 
 
 352 
 
Honours and Death 
 
 a Fellow of the Royal Society in i860, was 
 awarded the gold medal of the Society in 1880, 
 and the Copley medal in 1902, and becam.e 
 President in 1895. With the exception of Sir 
 Benjamin Brodie, he was the only medical man 
 in the century to receive that honour, and proved 
 himself exceptionally capable in mastering and 
 organizing the wide range of duties and scientific 
 interests the position involved. He was Presi- 
 dent of the British Association in 1896, and of 
 the surgical section of the British Medical Asso- 
 ciation in 1870 and again in 1875. He was 
 made an honorary LL.D. of Glasgow^ Edin- 
 burgh, Cambridge, Toronto, Montreal; D.C.L. 
 of Oxford ; Fellow of the University of London ; 
 and M.D. of Dublin^ Wiirzburg, Pesth, Bologna, 
 and Geneva. He was made a member of medical 
 and scientific societies of Paris, Amsterdam, 
 Pesth, Munich, Leipsig, Finland, St. Petersburg, 
 and Vienna. He was also made a Knight of the 
 Prussian Order, an associate of the Institute of 
 France, and a Knight Commander of the First 
 Class of the Order of the Danebrog (Denmark). 
 With all these honours, he is still described in 
 his latter years as one " always absorbed in his 
 own thoughts and almost timid." 
 
 In 1893 Lister, having reached the age of 
 sixty-six, had to surrender his appointment at 
 King's College Hospital. In the summer of the 
 same year he sufifered an irreparable loss. He 
 and his wife were spending the summer abroad^ 
 and whilst travelling in Italy Lady Lister con- 
 
 353 z 
 
Lord Lister 
 
 tracted pneumonia and died after a few days' 
 illness. The loss to Lister was peculiarly great. 
 The loneliness of genius has already been men- 
 tioned in this chapter. It seems to be an essen- 
 tial part of the distance of genius from other 
 men^ a distance which is not a gentle gradient 
 but a real gulf. Lister resembled other genius 
 in this. He was friendly with and invariably 
 courteous to other men, but rarely if ever in- 
 timate. Men^ howsoever devoted to him they 
 were, were always a little afraid of him. His 
 mood had to be awaited. Other men could not 
 break into it without finding that they had been 
 wanting in tact. His assistants and professional 
 friends would sometimes have to^ wait some 
 twenty minutes whilst he was pursuing a sub- 
 ject with his thought, before they could broach 
 a question ot a request. With women and 
 children — again, perhaps, resembling other 
 genius in this— he was far more at his ease. 
 Here the gulf between them and him was the 
 customary one between woman and man, or child 
 and adult. The suggestion that any profound 
 interchange was expected did not occur. With 
 children Lister was especially happy, and with 
 his little nephews and nieces played the most 
 ridiculous and absurd pranks, which only a man 
 who preserves and does not pass and forget his 
 youth, can play and enjoy. To^ such a man 
 a beloved wife forms a link of peculiar intimacy, 
 bringing him into a closer union with his fellow- 
 men. But when the link snaps, how much warm 
 
 354 
 
Honours and Death 
 
 and immediate intercourse with his fellows is 
 sundered too I It was so with Lister. That 
 rare communion of a supremely happy marriage, 
 which made a friend declare that these con- 
 tinental tours, even in the last years, resembled 
 honeymoon trips, was broken, and with it, so 
 to speak, the bond that bound him, an essentially 
 isolated and unique nature, most closely to his 
 fellow -men was broken too. The blow would 
 undoubtedly been far greater had it not been for 
 the place in his confidence and affections which 
 was held by his sister-in-law. Miss Lucy Syme. 
 This lady had been for many years an inVaJid, 
 and had lived much with the Listers. In the 
 latter years of Lister's life she shook off her own 
 illness and devoted herself to trying to fill with 
 care and love the place of her dead sister. 
 
 In 1903 Lister had a serious illness, from 
 which he never fully recovered, and in 1907 
 his general infirmity was very great. He suffered 
 from an affection of the joints and a general 
 wastage of body and power. He tired readily, 
 lost his capacity for work, suffered from failing 
 eyesight, and became, in short, a very old and 
 worn-out man. Nevertheless, he never lost his 
 kindly benevolence and gentleness of heart. Mr. 
 Irving Cameron, of Toronto, a warm defender 
 of antisepsis against the innovation of asepsis, 
 once gave the following description of a last 
 visit : " The last time I had the privilege of 
 seeing him was immediately before he left Park 
 Crescent for Walmer. I had called to leave 
 
 355 
 
Lord Lister 
 
 my card and make inquiry for him; as I always 
 did when in town. Although I knew he was 
 not seeing visitors^ some impulse moved me to 
 ask if he would care to see me, and being 
 answered in the affirmative I paid him my last 
 visit. He received me very cordially and affec- 
 tionately, and said he could not deny himself 
 to so old a friend, although he found that he did 
 not sleep after seeing people. I at once felt 
 that I was there under false pretences and that 
 my distinguished clansman. Sir Hector Cameron, 
 of Glasgow, had been expected and some con- 
 fusion had arisen between the voice of Jacob 
 and the hand of Esau. Of course I did not 
 stay long — and learned the next day that he was 
 none the worse for my visit — but I could not 
 have foregone the blessing of that occasion, for 
 when I told him as I took my leave that with 
 my ' brother ' of Edinburgh and his first disciple 
 in Paris " ( Lucas -Champonni^re just admitted 
 to L'Institut de France), " I still continued 
 to be and was likely to die an antiseptic 
 surgeon, the ineffable smile was on his lips and 
 the grasp of the ever-kindly hand made a 
 irrrtiia ig ad, an echo in the haunts of memory 
 of the master's presence and my antiseptic pledge 
 to him: while Reason holds her seat." 
 
 This was one of the last, possibly the last, 
 visit to Lister from the outside world, and I 
 hope the reader will share with me thfe gladness 
 which I feel that it was from a faithful follower. 
 
 Broken by illness and decrepitude, Lister left 
 
 356 
 
Honours and Death 
 
 London in 1909, and lived with his sister-in- 
 law in close retirement at Walmer, so quietly, 
 indeed, that only his most intimate friend's and 
 relatives knew of these last years. Consequently 
 London did not hear of his death until nearly 
 thirty hours after its occurrence. Though the 
 greatest of her sons, his very greatness kept him 
 from the garishness of modern publicity. 
 
 Lister died in the early morning of Feb- 
 ruary 10, 191 2. His death, like that of his 
 wife, was from pneumonia, and happened with- 
 out pain. 
 
 Lister expressed the desire dtiring his life- 
 time that he should be buried by the side of his 
 wife in the Hampstead Cemetery. Though there 
 was a general wish that he should be buried in 
 Westminster Abbey, his personal desire prevailed. 
 
 A national memorial service was held in the 
 Abbey upon February i6th. The King and 
 Queen were represented, the Prime Minister was 
 present in person. Austria-Hungary, France, 
 Germany, Italy, and Russia sent their Ambas- 
 sadors ; Belgium, Denmark, Greece, Sweden, 
 Norway, and Portugal their Ministers. Repre- 
 sentatives of all the leading scientific bodies at 
 home and abroad were present. Besides these 
 representatives a large number of distinguished 
 men attended. The service was brief but impres- 
 sive. The anthem chosen was Handel's " When 
 the ear heard Him." As the last words sounded, 
 " His body is buried in peace, but his name liveth 
 evermore," some felt, one thinks, the strange and 
 
 3S7 
 
Lord Lister 
 
 awful prescience that comes to men when the 
 meaning of immortality trembles upon their 
 earthly consciousness. For this service was 
 dedicated to a name and work over which death 
 shall have no power. It proclaimed the quali- 
 ties of paternal solicitude and provident goodness 
 to be related, not only to the earthly years of 
 man but also to the timeless perfections of 
 divinity. 
 
 358 
 
CHAPTER XV 
 
 CONCLUSION 
 
 Once more, with the reader's permission, we 
 will return to the philosophy of disease, in which 
 Lister fills so important a place, for it is limiting 
 his powers and value to consider him chiefly as 
 a surgeon. Lister was far more than that. His 
 early work upon the vitality of the tissues and 
 its issue in his lifework have enabled us to get 
 a comprehension of disease as a whole which 
 in value surpasses and includes the subsidiary 
 work of making modern surgery possible. 
 
 It must be clear, I think, to the reader who 
 has been impressed by the terrible stories of 
 the hospitals in our industrial centres before the 
 advent of Listerism or of the maternity hospitals 
 as recorded in the last chapter or of the Crimean 
 and Paris hospitals at times of war that mankind, 
 when crowded into small spaces, when shut from 
 the open heavens and the air cleansed by sun 
 and rain, and when divided from the food of 
 field, forest, and stream, only receiving it in the 
 cities after it has lost its pristine purity, a purity 
 which is unanalysable but as definite as the purity 
 of the air at dawn or any other supremely vital 
 
 359 
 
Lord Lister 
 
 thing, that it is then that disease casts the shadow 
 of death upon man and obscures in no small 
 measure the glory of life. 
 
 It must be clear, I think, that men when 
 crowded together, either for the purposes of 
 industry or those of war, no sooner become 
 wounded than they tend forthwith to harbour 
 microscopic forms of life and to foster them into 
 forms of ever -increasing malignancy, until such 
 men in association may be looked upon as verit- 
 able forcing-houses of pestilence, breeding from 
 microbes, which are harmless to healthy vitality, 
 monstrous demons of disease fraught with the 
 power to torture and to kill. 
 
 First the cramped town or camp and then the 
 yet' more cramped hospital, and the imprisoned 
 man suffers for his loss of freedom. The de- 
 creased vitality of man rears the microbe to a 
 colossal importance, just as the same crowded 
 conditions resulting from competitive industrial - 
 isih give a creed of the struggle for existence 
 a seemingly universal but really epochal 
 importance. 
 
 In the case of the diseases of hospitalism all 
 this is quite clearly shown by Lister's life 
 and work. These diseases were a peculiar pro- 
 duct of civilization, and especially of its peculiar 
 phase known as industrialism. They were 
 rendered possible in all their awfulness only by 
 the accumulative effect of a generally weakened 
 human vitality. For in so far as industrial civi- 
 lization meant a separation of man from the 
 
 360 
 
Conclusion 
 
 original sources of food and health, in so far 
 as it led to close concentration in cramped towns 
 and crowded factories, so men had to pay for 
 it by the contagious currency of disease. 
 
 And casting the eye over a wider range than 
 this most recent phase of civilization — namely, 
 the industrial — one sees that these peculiar 
 features of it do not wholly vanish and disappear. 
 One sees that the first separation of man from 
 an immediate relation with the natural sources 
 of health and vitality, however so good the inten- 
 tion of men may be, is met with a loss of human 
 vitality and the prominence of some lower forms 
 of life, which in nature seem to be only the 
 servants of death, but which in man affect him 
 seriously when alive and cast upon him the actual 
 shadow of death. It may, of course, be main- 
 tained that this is not strictly true, that even wild 
 and living animals suffer from microbic diseases. 
 But relatively it is true. The wild animals in 
 the natural state very rarely die of such diseases. 
 The microbes only overcome their bodies when 
 dead so as to effect putrefaction. But an active 
 state of putrefaction in the living animal seems 
 to be exceedingly rare. Put upon the animal, 
 however, any of the restraints of civilization and 
 the tale at once becomes a different one. 
 
 The very first disease of animal life that was 
 found to be due to microbes disclosed this secret. 
 It was one of the diseases of silkworms, known 
 as flacherie, and investigated by Louis Pasteur 
 when Lister was at Glasgow. The microbes of 
 
 361 
 
Lord Lister 
 
 flacherie were found to be powerless with 
 naturally fed worms placed upon wild mulberry- 
 trees. But the overcrowding of the worms in 
 the litters, the artificial temperature, the lack of 
 free flow of air, and the indigestible leaves of 
 prvmed and cultivated mulberry-trees so lowered 
 the vitality of the worms that they fell victims 
 in millions to the microbes of flacherie. 
 
 The same decreased vitality, which had such 
 a ruinous influence upon the silk industry in 
 France, is noted in the domesticated animals of 
 civilized man. Amongist cattle, who might be 
 said, as animals, to live a life of luxury and ease, 
 the commonness of tuberculosis is well known, 
 and it is a part of the price they pay for the 
 fatted life. But tubercle is not the whole price, 
 for, like other domesticated animals, they are 
 subject to all kinds of sicknesses unknown to 
 them in the state of freedom. Cancer, for 
 example, the disease which in foulness is the 
 most horrible, is practically or even completely 
 unknown amongst wild cattle, horses, sheep, 
 goats, or deer ; but Mr. Rollo Russell writes, 
 in the only philosophic outlook upon cancer with 
 which I am acquainted, "it is much more 
 common amongst domesticated creatures, such 
 as cows, pigs, pou,ltry, and fattened beasts, more 
 common in cats, and most in dogs." Cancer is, 
 in fact, part of the payment which these animals 
 have to make for the advantages of civilization 
 which man has thrust upon them. 
 
 Civilized man has the same payment to make 
 
 362 
 
Conclusion 
 
 in fuller measure, and where he is most civilized 
 there his payment is heaviest. The payment in 
 " hospitalism," until Lister checked it, was heavy 
 enough, but it did not record the full payment 
 of industrial towns in rickets, insanity, nervous- 
 ness, venereal disease, alcoholism, deformities, 
 difficult childbirth, the loss of the zest for life, 
 which collectively are still as marked as ever. 
 As yet, also, cancer has been wholly unchecked, 
 for no philosopher, such as Lister was, has read 
 its secrets, only the surgeons treat it. Cancer 
 consequently forms a good measure of nian's pay- 
 ment for being civilized, for the peculiar loss 
 of human vitality that permits it to cast its shadow 
 upon man seems to increase step by step with 
 man's gain in civilization. It is a disease of 
 towns above all, and where the p>opulation is 
 most wealthy there cancer also reaps its richest 
 harvest. But where civilization, and particularly 
 European civilization, is not advanced, there 
 cancer is as yet powerless. " The countries of 
 immunity," writes Mr. Russell, " or where cancer 
 is rare, were : most of Northern, Central, West, 
 East, and South Africa, where natives were apart 
 from civilization or European customs ; a large 
 part of Asia, especially the tropical regions, where 
 habits were frugal, or where certain peculiar 
 customs were not prevalent ; large parts of India, 
 China, Burmah, and Siam ; many of the islands, 
 especially New Guinea and Borneo ; the native 
 locations in Australia ; the Fiji Islands, parts of 
 the West Indies ; parts of Brazil and of Mexico ; 
 
 363 
 
Lord Lister 
 
 and apparently native Java and Sumatra. . . . 
 Races and persons little subject to cancer very 
 quickly become subject on entering new con- 
 ditions where European or American fare is 
 taken. This applies to negroes, Chinese, and 
 apparently all races. Europeans accustomed to 
 their ordinary moderate fare quickly become 
 more subject after they have changed to richer 
 fare." 
 
 It is the same story with the disease, which in 
 horror alone rivals cancer— namely, tuberculosis. 
 Practically everybody who lives in modern towns 
 suffers at some time from tuberculosis, said 
 Professor Metchnikoff, in the Priestley Lecture 
 of 191 2. " It is well known that tubercular 
 disease has spread all over the world— in tropical 
 regions and the islands of the Pacific and 
 Atlantic, and such regions as South America and 
 South Africa, once free from tubercle, but now 
 exposed to it by the immigration of Europeans. " 
 The Professor gave an instance of this change, 
 which was personally known to him. The 
 Kalmuks are a group of nomadic shepherds, and 
 were found by the Professor to be free from 
 tubercle, especially when they were living at a 
 distance from the influences of the Russian 
 civilization. Nowadays a large number of 
 Kalmuk boys come to Russian towns for educa- 
 tion, and secure not learning only but tubercle 
 as well. 
 
 That whi<ih was seen in Lister's lifework 
 seems, then, to be no isolated picture, but one 
 
 364 
 
Conclusion 
 
 that marks civilization. It seems, indeed, that 
 the answer to the mystery of disease may almost 
 be given— namely, that it is the debt man pays 
 when he allows his civilization to lead him away 
 from certain primary habits of life. But I hasten 
 to say that, philosophically regarded, it is not 
 a punishment for not leading what is now known 
 as the simple life. A civilization of the highest 
 culture and imperishable grandeur, such as the 
 ancient Egyptian, may be founded upon the 
 simplest physiological and bodily habits. Com- 
 plicate those habits and remove them from the 
 primary sources of health, and disease, with its 
 various specific kinds and forms, becomes a per- 
 petual accompaniment of life. Disease is allied 
 to death ; it is itself the shadow of death . And 
 so one comes to see that certain forms of civiliza- 
 tion that are not founded upon and permeated 
 by physiological laws are in themselves allied 
 to death. They neglect what in nature seems 
 to be the ultimate aim— namely, the cultivation 
 of a refined and perfect vitality, the highest 
 excellence in the quality of life ; until, if retri- 
 butive justice be indeed a law of Providence, the 
 neglect of the rightful interpretation of the true 
 purposes of being leads to the shadow of death 
 clouding the brightness of men's days. 
 
 Through its own sickness a civilization has 
 to be healed or else to be destroyed. History is 
 full of records, in which peoples of more crude 
 animal health swept away civilizations that had 
 occupied centuries in the building. But our 
 
 36s 
 
Lord Lister 
 
 civilization represents a peculiarity unique in the 
 history of the world. Unless the Yellow! Peril one 
 day proves itself a reality, or thfe hosts of Africa, 
 under the marvellous inspiration of the Arabs, 
 sweep over an effete Europe— both possibilities 
 that at present seem scarcely credible— our 
 civilization, if sick, is bound to cure itself. There 
 are no people of rude health capable of sweeping 
 it away. 
 
 That it has been and is still serio.usly sick, 
 physiologically and bodily sick, no reader of 
 these pages can, I think, doubt. It is no exag- 
 geration to say that had it not been for 
 Semmelweiss and Lister, industrial civilization 
 might have come to a standstill through the 
 number of mothers slain, the number of men 
 destroyed, the accumulation of the maimed and 
 the invalid. 
 
 Of these two Semmelweiss became forgotten, 
 but Lister succeeded ; and it is significant, with 
 a significance that is startling, that he, the most 
 effective genius of his century in the general 
 interests of humajiity, had to turn his vast powers 
 upon the problem' of putrefaction, and, in place 
 of more positive fields of labour, had to make 
 himself the master of corruption. It was he, 
 above all men— above Semmelweiss, , above 
 Pasteur, above all the many speculative philoso- 
 phers of the age— who realized the primary fault 
 which civilization had brought about, namely, the 
 weakened vitality of man, and especially of the 
 men upon whom that civilization pressed most 
 
 366 
 
Conclusion 
 
 heavily. As he first saw the vitality of the frog's 
 web paralysed, so he saw man in part paralysed 
 and all the allies of death making triumphant 
 assaults upon his weakened defences. To this 
 partial human paralysis he brought the truest 
 ally. The antiseptic, microbe-killing power of 
 man's blood and tissues was too weak, and Lister 
 brought to it a true and philosophical ally- 
 namely, an antiseptic lent to the body for so long 
 as it had need of it. By so doing he turned the 
 failure of the unaided powers into a triumph. He 
 not only showed the root and cause of the great 
 prevalence of microbic diseases (and, by infer- 
 ence, other diseases)— namely, the weakened 
 vitality of man, but he also showed how the 
 disasters due to this weakened vitality might be 
 averted. 
 
 It is clear, however, that the aid which he 
 brought was com|parable to that of mercenary 
 troops . It was hired aid ; and, indeed, so long 
 as the conditions producing this weakened vitality 
 prevail, so long must we rely on hired aid. But 
 of all hired aid that of antiseptics is the mbst 
 philosophic, in that it is the most generally 
 applicable. When once the antiseptic has 
 reached the microbes, there are none that can 
 finally resist. It does not matter what the 
 peculiar microbe is that reaches the wound, 
 carbolic will be able to destroy its danger. 
 
 The other well-known method of coming to 
 the aid of the diminished vitality of man is by 
 the use of vaccines and serums. Serums are 
 
 367 
 
Lord Lister 
 
 special antiseptics which destroy special microbes 
 and none other, and their value depends upon 
 the doctor being able to detect the peculiar brand 
 of the microbe that is already actively producing 
 disease in the body. When the disease is actually 
 there the injection of the right serum does some- 
 times help the body to overcome the disease, 
 but the method can have no general application, 
 and has always to await the onset of the disease. 
 The vaccine, on the other hand, increases the 
 power of the blood to overcome one particular 
 form of microbe. The method of vaccination 
 was foimded, not upon a philosophical under- 
 standing of vitality but upon the experience of 
 dairymaids and cowkeepers. Jenner's work was 
 empirical. Lister's philosophical. The danger of 
 empiricism is that it is always specific ; its value 
 depends upon a particular case or conditions. 
 But a philosophical treatment, being founded 
 upon a general principle, has a general applica- 
 tion. The philosophy of vaccination, one may 
 say, does not really exist. There is in it no 
 unified principle. Experience alone has shown 
 that in certain diseases an attack, even if slight, 
 seems to guard a man against another attack. 
 But this is only true of certain diseases. With 
 a number of other diseases one attack, in so far 
 from conferring immunity, actually predisposes 
 the patient to further attacks — malaria, dysentery, 
 pneumonia, influenza, and common colds being 
 examples. Therefore the vaccine method of 
 aiding the diminished vitality of man, which 
 
 368 
 
Conclusion 
 
 would require a separate vaccination for every 
 separate disease, is not even feasible. The most 
 one can say for the vaccine method is that where 
 one particular disease prevails in a threatening 
 manner, then if it can be staved off by a method 
 of vaccination its use is legitimate. But such 
 a method is not philosophical or fundamental ; 
 it is only specific and empirical. It seems even 
 possible that a vaccine protects against one 
 disease by concentrating the blood's vitality 
 against that disease and so weakening its 
 resources against other diseases and degenera- 
 tions. One may, in fact, make a cream from 
 the blood to resist a certain disease and be left 
 with only skim milk for the rest — a process only 
 justifiable if the particular disease is especially 
 threatening to life itself. 
 
 Therefore, so long as man suffers from a 
 weakened vitality which makes him peculiarly 
 liable to disease, and so long, therefore, as he 
 needs an antiseptic ally. Lister's method seems 
 to be the wisest and most philosophical. By 
 it, when man is wounded and there is in him 
 a local point of microbic attack, the aid of anti-. 
 septics may be directly and temporarily given 
 to him. By it all foci of putrefaction that occur 
 particularly in cities, such as drains, rubbish- 
 heaps, dead animal matter, as well as the actual 
 discharges of infected woimds and people, may 
 have their danger destroyed. 
 
 Until, therefore, some national physiological 
 regime is established which has for its aim the 
 
 369 AA 
 
Lord Lister 
 
 cultivation and preservation of the vitality, which 
 makes so many diseases impossible, a medical 
 profession adhering to a strict antiseptic ortho- 
 doxy would do untold good. But orthodoxy is 
 necessary for several reasons. Firstly, it limits 
 the freedom of choice which is at present allowed 
 to men incapable of right judgment in difficult 
 matters ; secondly, it produces a unity of per- 
 formance the general results of which can be 
 estimated ; thirdly, it simplifies action greatly 
 and prevents the chaotic muddle in which medical 
 practice at present exists, and in which new and 
 unproven remedies are constantly being offered 
 to the medical practitioner, they being advertised 
 either by articles in the medical papers or 
 directly by tradesmen and manufacturers — a 
 muddle that would be far worse were not the 
 practitioner prevented from using his freedom 
 to try any of these remedies by his own inertia 
 and lack of time ; fourthly, it would give con- 
 fidence to the public, who would know more or 
 less what to expect from a doctor and what to 
 do themselves to help him, instead of the lack 
 of confidence generally felt owing to the total 
 inability of the laity to know where one par- 
 ticular doctor has fixed his temporary faith ; 
 lastly, it would give to the profession the form 
 of an art and of orglanization in place of the 
 disintegrated confusion of a competitive trade. 
 I think, therefore, that no better tribute could 
 be paid to Lister than by the issue of a cheap 
 copy of his works, which all medical students 
 
 370 
 
Conclusion 
 
 should be compelled to read. Further, opera- 
 tions and midwifery, conducted with Lister's 
 antisepsis, and in the former case with his exact 
 technique, should be shown to the students, and 
 " Listerism " should be made one of the subjects 
 of the final examination. Only in this way can 
 the full benefit of Lister's great personality be 
 reaped by the profession and, through them, by 
 the public. 
 
 With this training in orthodox Listerism, one 
 or two lectures upon Lister's personality and life 
 might well be combined. There is no personal 
 or ethical training in the whole course of a 
 student's training to-day. It is as if ethics and 
 personal character had nothing to do with the 
 practice of medicine— at least nothing sufficiently 
 definite to permit of speech. Yet the indication 
 to students of a certain ethical standard is as 
 necessary to ensure the best practice of ortho- 
 doxy in the medical profession as it is elsewhere. 
 As Professor von Mikulicz-Radecki, one of 
 Lister's early pupils and friends, said of the 
 antiseptic system, so one may say of medical 
 practice in general : a special quality of 
 character is required to its employment as well 
 as technical instruction— namely, a character of 
 precision and consistency. It was characteristic 
 of the founder of the system and is necessary 
 in the follower. " If this quality is wanting to 
 any one, he will remain, in spite of all ability, 
 a bungler in the treatment of woimds." And the 
 inculcation of this quality could scarcely be 
 
 371 
 
Lord Lister 
 
 better attempted than by holding up the 'per- 
 sonality of Lister to the students and doctors of 
 the day. 
 
 For as the antiseptic system in its simplicity, 
 effectiveness, and general application is an ideal 
 aid to civilized man against microbic ills, so the 
 character of Lister was that of the ideal 
 physician. We cannot, of course, all have 
 genius, we cannot all have the qualities of 
 excellence in the abundance with which 
 they were granted to Lister. But the 
 supreme example of an exalted personality is 
 ever of great value ; it always forms a definite 
 ideal at which to aim. It has seemed to me, 
 though I myself belong to the profession, that 
 medical men in sacrifice, sense of duty, and kind- 
 ness of heart surpass the members of any other 
 way of life. Our calling is sometimes said to 
 produce callousness, but I believe all will agree 
 that the callous doctor is far rarer than the kind. 
 It is truer, I believe, to say that the profession 
 of healing attracts boys of kind and generous 
 humanity, and that, when they become men, the 
 suffering they see amongst men, women, and 
 children broadens and deepens the feelings of 
 their hearts. 
 
 To-day, in the stress of competition that arises 
 out of the general eag'erness for wealth, the 
 humaner qualities of mankind have not, perhaps, 
 the same chance to ripen and flourish as in days 
 when the family rather than the individual was 
 of chief importance. In the past a practitioner's 
 
 372 
 
Conclusion 
 
 relation to his patients was more intimate, he 
 forming almost another member of the family. 
 To-day this happy position is less frequent. The 
 need of regarding a practice as a business 
 enhances the commercial qualities to the detri- 
 ment of the more kindly feelings of service and 
 solicitude. Though I believe doctors as a whole 
 are less affected by this general change than 
 any other class of men, still the example of 
 Lister's character is a gift of quite equal value 
 to that of the antiseptic system' ; but it is one at 
 present neglected. In the whole of my student 
 career no lecture was ever given upon Lister's 
 work and character. Lister was, of course, at 
 that time in active work, and no doubt lectures 
 upon his character would not have been so seemly 
 as they would be now. But now that he is 
 dead his quality should be memorized in the 
 mind of every student. 
 
 For, as one closely related to him recently said 
 to me, probably no man ever went through life 
 with less regret and more to rejoice in than 
 Lister. In an even higher sense than of old he 
 was a saint, for he dispensed material and bodily 
 good in addition to the spiritual power, which 
 every one gained who came into close contact 
 with him. No man ever carried out a great 
 revolution, and yet won, with very rare excep- 
 tions, from all who opposed him but became 
 personally acquainted with him, a more generous 
 admiration and respect. He was strong, but he 
 was gentle ; he was resolute, but courteous. 
 
 373 
 
Lord Lister 
 
 When he first became a surgeon to the Glasgow 
 Infirmary by his firmness he resisted and pre- 
 vented the overcrowding that was common to 
 the wards of the hospital. He would not allow 
 expediency or the need of standing well with 
 the managers to interfere with efficiency. The 
 same firmness was his throughout his life. Based 
 upon his direct observation of the good that re- 
 sulted from his work, he was inflexible in its 
 pursuit. No desire to protect his own person 
 from attack ever drew him from his work, unless 
 the attack was directed against his honour. No 
 attack against his work ever distracted him, 
 unless it was from one whose authority might 
 do it serious hurt. His answers were then brief 
 and to the point, and his only rebuke a quiet 
 irony. In all the controversy and hostility his 
 innovations provoked his judgment was ad- 
 mirable. True to himself, he never allowed 
 animosity to disturb the serenity which was 
 necessary to the cool and untroubled continua- 
 tioh of his work and the dispassionate criticism 
 he devoted to it. His serenity was absolute and 
 woli the praise of his foes. His sense of the 
 high nature of his calling was peculiarly vivid. 
 " To intrude an unskilled hand to such a piece 
 of divine mechanism as the human body," he 
 was wont to say, " is indeed a fearful respon- 
 sibility." It was this sense of responsibility, a 
 responsibility particularly heavy in the case of a 
 man of his unequalled powers, that caused Lister 
 to devote such unwearying energy to the allevia- 
 
 374 
 
Conclusion 
 
 tion of suffering humanity, that almost as a whole 
 seemed to have been placed by Providence in 
 his charge. It was this that made him, a man 
 of sufficient private means to enjoy most of the 
 luxuries of life, to follow a life of extreme 
 simplicity. It was this that made him devote 
 the early morning hours month after month to 
 the laborious experiments, which the neglect of 
 some trifling precaution or a little laxity in 
 thoughtful carefulness would have rendered 
 useless. 
 
 His courtesy was invariable, and he treated 
 all with the most gentle consideration. But it 
 did not prevent him from rebuking people, where 
 a rebuke was justly merited. On one occasion, 
 for instance, a pompous, bustling practitioner 
 introduced himself to Lister as an old college 
 friend. It was when the antiseptic system was 
 well established. The practitioner expressed his 
 surprise at the strangeness of fate. " Here are 
 we. Sir Joseph," he said. " I am unknown 
 and you famous everywhere for this antiseptic 
 system. Not that there is anything in it. I 
 would not let any of my patients have any of 
 these new-fangled methods. I would not even 
 try them on any one." " Sir," replied Lister 
 quietly, " if your patients knew what I know, 
 they would not let you enjoy the honoured name 
 of a physician." 
 
 " A feeling heart is the first requisite of a 
 surgeon," Lister once replied to a questioner. 
 It was the feeling heart that above all directed 
 
 375 
 
Lord Lister 
 
 his life. It made him to his family a member 
 of deep affection, loved and respected by the 
 elder members, delighted in by the younger 
 members, amongst whom he readily became the 
 child, using his creative power to invent romp 
 or story with originality and variety such as 
 children especially love. To his faithful partner 
 in life he gave a love and tenderness that caused 
 his friends to speak of husband and wife in their 
 last years together as like lovers on their wedding 
 trip. The impulses of the heart of a really noble 
 nature in the family show themselves in intimate 
 affection, in the outer world in a tender solicitude 
 to and unwearying thoughtfulness for others. To 
 his students and those who served him Lister 
 showed the bounty of an acknowledged master, 
 zealous in giving them all the share of his power 
 that they could take. He did not only give 
 them the lectures and classes, which were their 
 due, but whenever he had spare time he would 
 devote it to them, giving them the peculiar skill 
 that he alone could give. On Sundays, we are 
 told, in the morning he would attend church 
 with his wife, but in the afternoons, instead of 
 taking his ease, he would go to the infirmary 
 at Edinburgh, accompanied by his keenest pupils, 
 and there talk over cases and treatment with 
 them. He was ever ready to welcome pupils and 
 doctors to his house if he had experiments to 
 demonstrate or records of work and cases to 
 show them. Foreigners and countrymen all 
 testify to the unfailing care and patience with 
 
 376 
 
Conclusion 
 
 which he again and again unfolded' his doctrine 
 to them. In money, too, he showed the same 
 generosity, helping students, professors, and 
 scientists alike. A friend of his, for instance, 
 mentioning a poor student who had no money 
 to finish his course received at once a cheque 
 for £50 from Lister to be given to the student 
 with his best wishes. He was one who was 
 wont to presuppose a goodness in other men of 
 like kind to his own — a characteristic which, whilst 
 usually calling forth the best in other men in 
 response, sometimes led him to be imposed 
 upon by unworthy applicants for his help. He 
 trusted men so much that he was wont to 
 leave his fees to what they considered just and 
 right . 
 
 To his poor patients he showed the same care 
 as he showed to the rich. " He likes the little 
 yins best and the auld womfen," whispered a 
 street urchin who was under his care as the chief 
 passed from the boy's bedside. His solicitude 
 for his patients was unremitting, and, as he was 
 one whose gifts were never partial, he always 
 staunchly refused to turn a patient from the 
 hospital, though months were taken up in the 
 last stages of a lingering recovery. He did not 
 understand a lesser sense of humanity. " When 
 Lister left Edinburgh in 1877," said Mr. Grasset, 
 of Toronto, one of his favourite house-surgeons 
 and author of an affectionate memento, " there 
 were eight cases in his wards of psoas abscess — 
 seven men and boys and one woman. Lister 
 
 377 
 
Lord Lister 
 
 thought they would remain in the hospital under 
 a mandate until they got well. Dr. John Stewart 
 tells me that shortly after Lister went to London 
 it was decided to turn these patients out. Caird 
 wrote to Stewart and asked if the girl, a lady's- 
 maid from the South of England, would be taken 
 in at King's. ' I shall never forget,' he says, 
 ' the pained look of surprise in Lister's face when 
 he heard his patients were turned out.' I wired 
 Caird, ' Yes,' and that night she left for London 
 under the care of a nurse, transported in one 
 of those long baskets which in Edinburgh were 
 used to carry patients to the operating theatre, 
 manned by the dressers of the surgeon. She 
 ultimately g'ot quite well, and the ' chief,' writing 
 a year or two later, said that he had seen her 
 walking and looking bright and well. Lister 
 had the men and boys taken from the infirmary 
 to a nursing home where he used to operate in 
 Edinburgh. He put them under the care of 
 his old assistant, John Bishop, and paid all the 
 expenses connected therewith, including attend- 
 ance and dressing. In the end all of them got 
 perfectly well." 
 
 Such was the perfection of his paternal solici- 
 tude for all who were committed to his charge. 
 And it is fortunate that one of the greatest 
 problems in the fate of man was subniitted to 
 him and that, prompted by his great compassion 
 and made capable by his consummate genius, 
 he mastered it and became therefore a benefactor 
 to mankind in such bountifulness that his equal 
 
 3;8 
 
Conclusion 
 
 could scarcely be found amongst the children 
 of this world. 
 
 Lately I was standing beside his grave in the 
 Hampstead Cemetery. A plain, grey granite slab 
 covers it, upon which man has written the 
 simple inscription : " Joseph, Baron Lister, bom 
 5th April, 1827; died loth February, 1912." 
 The memory came to me of the legend of St. 
 Sophia and of the angel's hand which wrote upon 
 the slab above the western door. And I thought 
 that upon this grey slab some angel hand might 
 also write without profanation the noblest of 
 texts : " And all generations shall call me 
 blessed." 
 
 379 
 
INDEX 
 
 America, testimony of, 198, 263 , 
 Annandale, Thomas, 49 
 Aseptic system, so-called, and 
 Lister's system, 312-336 
 Expense of, 332, 333 
 Asoka, King, 63 
 Austria, testimony of, 263 
 
 Babylonians, the, 9 
 
 Bastian, Charlton, 63 
 
 Bell, John, 68-79 
 
 Bell, Joseph, 201, 226 
 
 Bennett, Hughes, 135,212-215, 218 
 
 Bergmann, Ernst von, 330, 331 
 
 Bloch, Oscar, 328 
 
 British Medical Association, 129, 
 
 13s, 192, 244, 305 
 British Medical journal, 197, 273, 
 
 284, 286, 290 
 Brown, John, 39, 44, 80, 272 
 Buddhist hospitals, 63 
 
 Cameron, Hector, 66, 67, 85, 326, 
 
 335 
 Cameron, Irving, 355, 356 
 Carlisle and carbolic acid, 104 
 Champonniere, Lucas, 225, 326- 
 
 328 
 Cheatle, George, 340 
 Cheyne, Watson, 274, 286, 307 
 Chiene, John, 226 
 Christian hospitals, 63, 64 
 
 Christison, Robert, 44, 251 
 Cleanliness, rarity of, 87 
 Cooper, Astley, 88 
 Cresswell, Pearson, 185, 186 
 Crimean hospitals, 230-232 
 
 Darwin, Charles, 30, 97, loi, 127 
 Denmark, testimony of, 263 
 Duplay, Simon, 262 
 
 Edinburgh Infirmary staff, 201-204 
 Egyptians, the, 9, 63 
 Erichsen, John, 120, 127, 133 
 Ethical example, need of, 371-373 
 
 Fermentation and putrefaction, 
 
 92-100 
 France, testimony of, 198, 262 
 Frederik's Hospital, Copenhagen, 
 
 161 
 French military medical service, 
 
 237-240 
 
 Galen, 10 
 
 Gamgee, Sampson, 249-251 
 
 Genius, 58-60, 83 
 
 George IV, 88 
 
 Germany, testimony of, 198, 252- 
 
 262 
 Glasgow Infirmary, 81, 82 
 Godlee, Rickmann, 275 
 Goethe, 86, 292, 293 
 
 381 
 
Index 
 
 Graham, Thomas, 27, 148 
 Grasset, Frederick, 377 
 Greeks, the, 10, 63 
 Gurney, Samuel, 18 
 
 Harvey, William, 1 1 
 Helmholtz, Hermann von, 91 
 Helmont, Jean van, 11, 53 
 Henley, William, 167 
 Herschel, John, 42, 49 
 Hewitt, Prescott, 280 
 Hill, Berkeley, 187, 188 
 Hippocrates, 10 
 
 Holmes, Timothy, 133, 274, 279 
 Hospital gangrene, description of, 
 
 72-78 
 Hotel Dieu Paris, 66, 73 
 Howard, John, 65, 66 
 Hunter, John, 140 
 Hutchinson, Jonathan, 135 
 Huxley, Thomas, 251 
 
 International Medical Congress, 
 
 287, 309 
 Italy, testimony of, 263 
 
 Jenner, Edward, 368 
 Jenner, William, 227, 228 
 
 Keith, Thomas, 201, 281 
 Koch, Robert, 304 
 
 Lancet, the, 173-17S, 248, 249 
 Latour, Caignard, 90 
 Lawrence, William, 140 
 Leeuwenhoek, Anthony van, 1 1, 90 
 Leraaire, Jules, 176, 181 
 Leyden University founded, 65 
 Liebig, Justus von, 91 
 Lindley, John, 27 
 Lister, Agnes, 42, 275, 353-355 
 Lister family, 18 
 
 Lister, Joseph- 
 Amsterdam, reception at, 287- 
 
 289 
 Answers to opponents, 159, 176, 
 
 177, 182, 183, 192, 195, 250, 
 
 284, 285 
 Antiseptic theory, 171, 172 
 Appearance, 34, 60, 61, 205, 206 
 Articles in Holmes' Surgery, 338, 
 
 339 
 Artificial scab, 295-304 
 Birth, 17 
 Boldness, 294 
 
 Carbolic acid, introduces, 104 
 Carbolic spray, 307-310 
 Character, 165, 166, 373-378 
 Chronic abscess, 1 19-128 
 Compound fractures, first anti- 
 septic experiments in, 105- 
 118 
 Death, 357 
 
 Edinburgh, visit to, 351 
 first lecture, 207-212 
 first period, 41-61 
 last lecture, 270, 271 
 Edinburgh Infirmary — 
 appointed professor to, 157 
 assistant surgeon to, 48 
 cleanses wards of, 163-165 
 Energy, 49 
 Escapades, 43 
 Examination honours, 26 
 Faith, 125 
 
 Foreign tours, 34I-350. 352 
 Franco-German War, 241-243 
 Germany, visit to, 260 
 Glasgow, 81 
 
 visit to, 351 
 Glasgow Infirmary — 
 appointed professor to, 61, 62 
 cleanses wards of, 150-155, 
 157-159 
 
 382 
 
Index 
 
 Lister, Joseph (continued) — 
 Hampstead Cemetery, 357, 379 
 Honours, 353 
 House surgeon, 32, 42, 48 
 Inflammation and vitality, work 
 
 upon, 49-58 
 King Edward VII, 341 
 King's College Hospital — 
 
 appointed professor to, 270 
 
 first address, 274-276 
 Ligature, work upon the, 138- 
 
 149 
 London residence, 337 
 Marriage, 42 
 Operative technique, 128, 137, 
 
 304. 305 
 Operator, as an, 339 
 Pasteur's experiments, repeats, 
 
 215-222 
 Pasteur's Jubilee, at, 349 
 Pasteur's papers, reads, 97-100 
 Perseverance, 125 
 Philosopher, as, 7, 84, 85, 
 
 2S9 
 Plymouth, address at, 244-247 
 Research, first, 29 
 Royal honours, 340, 341 
 Royal Society, at, 352 
 Schooling, 21 
 Serenity, 61 
 Simplicity, 294 
 Students attitude to, 200-204, 
 
 269 
 Surgical cleanliness, 87, 89 
 Teacher as, 200, 206, 224 
 University College, 22, 35 
 Verses on, 272 
 Vivisection, 52, 145 
 Westminster Abbey service, 357, 
 
 358 
 Works published, 334 
 Lister, Joseph Jackson, 18-20, 47 
 
 London surgeons and antiseptic 
 system, 186-192, 196-198, 
 273-291 
 
 Macleod, George, 136, 199 
 Medical education at beginning 
 
 of last century, 24, 25 
 Metchnikoff, Elias, 364 
 Mikulicz-Radecki Johann von, 371 
 Millbank, 42 
 Mohammedans, The, 11 
 Mohammedan hospitals, 64 
 
 Nightingale, Florence, 231 
 Nunneley, Thomas, 192-195 
 Nussbaum, Johann von, 236, 254- 
 256, 266, 267 
 
 Operations, new, 281, 282 
 Ovariotomy, 281, 282 
 
 Paget, James, 192, 279 
 Pare, Ambroise, 138 
 Pasteur, Louis, 90-104, 348-350 
 Philosophy of disease, 359-369 
 Porter, Mrs., 43 
 Pouchel, Felix, 93, 94, 96 
 Pre-Listerian hospitals, 66-79 
 Pringle, John, 102 
 Prussian military medical service, 
 232-236 
 
 Queen Victoria, 227-229, 340 
 
 Roman hospitals, 63 
 Russell, Rollo, 362, 363 
 
 Savory, William, 283 
 Saxtorph, Mathias, 160-163, 225 
 Schwann, Theodor, 90 
 Science, 58, 59, 168-171, 214 
 Semmelweiss, Ignatz, 342-347, 366 
 
 383 
 
Index 
 
 Sharpey, William, 27, 28, 37, 41, 47 
 Simpson, James, 129-137, 141, 142, 
 
 150, 177-184, 34S 
 Smith, Tom, 267 
 Spence, James, 285 
 Spontaneous generation, 93 
 Stewart, John, 274, 339 
 Suppuration after compound frac- 
 tures, description of, 69-71 
 Surgical hospitals, 129-134 
 Sweden, testimony of, 263 
 Syme, James, 27, 37-48, 81, 142, 
 
 155-157. 202, 205, 224 
 Syme, Lucy, 42, 355 
 
 Testimony, early, 184, 251 
 Thiersch, Karl von, 258, 259 
 Tradition, need of antiseptic, 369- 
 
 371 
 Tyndall, John, 251, 302 
 
 Volkmann, Richard von, 256-258 
 Voltaire, 93 
 
 Wakley, James, 173-175, 186, 189, 
 
 191, 197, 248 
 Wakley, Thomas, 173 
 Wells, Spencer, 281 
 Wood, John, 276-279 
 
 UNWIN BKOTHERS, LIMITED, THE (IKESHAM PRESS, WOKING AND LONDON.