Joseph Lister in the Library - "Careful procedure and attention to detail" - applying Lister’s research

Our second blog post relating to the Joseph Lister collections at the Royal College of Surgeons of England Library and Archives examines the research career of Lister and how his antiseptic method made large scale changes possible in the surgical world during and after his lifetime.

“Portrait of The Right Honourable Joseph Lister, 1st Baron Lister [1827-1912]”, from the Centenary volume. T. & R. Annan & Sons, Ltd.

The printed collection contains many of Lister’s articles, and also contemporary writing from his colleagues, who pay tribute to his work and his character, and reflect upon his contribution to a watershed moment in the history of safer surgery and better patient outcomes.

“Group portrait of The Right Honourable Joseph Lister, 1st Baron Lister [1827-1912], with his colleagues”, from the Centenary volume. T. & R. Annan & Sons, Ltd.

The impact of Lister’s work can scarcely be overestimated: as Harold Ellis describes, his 1865 operation on a compound fracture as making the difference between the primitive and modern eras of surgery. The 11 cases he treated before publishing his work “On a new method of treating compound fracture, abscesses etc., with observations on the conditions of suppuration” in The Lancet, contained only one fatality – a statistic that would have been unheard of without his carbolic acid interventions. This type of injury frequently required amputation, which in itself often proved fatal even before high rates of post-operative infection set in.

Lister’s article in The Lancet.

The improvements in outcome continued in the years after, with Lister recording 40 amputations performed in the period 1867-70 with only 6 deaths, or 15% mortality compared with 35 amputations in the years 1864-66 of which 16 died, a 46% mortality.

Lister’s writing records the shift that these improved outcomes had in terms of allowing surgeons to feel more confident to operate on their patients. Ellis notes “Before Lister surgeons hesitated to inflict an incision through the intact skin because of the extreme risk of wound infection, which was often fatal”.

Lister operated on cases such as that of a gross malunion of the ulna, performing an osteotomy on the bone that lead to a situation similar to a compound fracture; amazingly this also healed without problems. Before the antiseptic method this kind of intervention would have been considered grossly risky and improper behaviour in the circumstances. He also performed an open reduction of a fractured patella, wiring two fragments together and reporting on the successful healing of the wound.

Another article, this one from the British Medical Journal.

Lister’s research was also aimed at addressing the imperfect practice of ligating arteries. He adopted the practice of soaking his silk tying cord with carbolic and cutting it short to be contained within the body. He tried this method first on a horse and later a 51 year old woman with an aneurysm of the femoral artery. He then swopped silk for catgut (actually made from the intestines of sheep). Continuing to mull over the best ways to sterilise the catgut for the rest of his life.

The advent of anaesthesia suited Lister’s own preference not to rush a surgery and he emphasised this to his students remarking that “anaesthetics have abolished the need for operative speed and they allow time for careful procedure”, adding “success depends upon attention to detail”.

Joseph, Baron Lister : centenary volume 1827-1927. By Turner, A. Logan (Arthur Logan), 1865-1939.

Arthur G. Wood’s handwritten account.

A cutting showing the spray apparatus that Lister used.

In 1877 he accepted an invitation to the Chair of Surgery at King’s College, London. Whilst there Arthur G. Wood served as one of Lister’s surgical team. Arthur's personal account of acting as a dresser (a surgical assistant who dressed wounds) for Lister, makes fascinating reading:

My duty was to hold a large Carbolic Spray. The Professor operated as a rule in a small Ward. He, his H.S. and anaesthetist as well as the Dressers were enveloped in mackintoshes and thoroughly drenched with Carbolic Spray: and then as he operated, we directed the spray on to the field of operation: one’s vision was obliterated by the spray from the powerful spray producers.

This handwritten account is contained in a memorial volume produced to celebrate Lister’s life which was recently generously donated to the Library by the Wood family. The inserts also show photographs of the type of carbolic sprays used in early antiseptic surgery.

A British Medical Journal volume containing one of Lister’s articles in the Lumley Library.

The tributes to Joseph Lister during his lifetime and after his death show the high regard in which he was held and the impact that his research had on the practice of surgery. The Library holds a selection of these writings, where the skepticism and opposition that he had experienced before his anti-septic system was accepted as scientifically sound gives way to fulsome and devoted praise. On the day of his funeral many tributes from learned societies all over the world were published in The Times and the Lister Medal was founded to recognise surgical excellence, being considered as one of the most prestigious prizes that can be awarded to a surgeon.

A shelf of tributes in the Research Room.

If you would like to visit the Library to consult the Lister Collections please consult the catalogue and then email the Library and/or the Archives to make an appointment. To view any of the printed Lister material, please email us at library@rcseng.ac.uk, or to view the Archive Lister Collections, please email archives@rcseng.ac.uk.

Select Bibliography by Baron Joseph Lister 1827-1912

• On the minute structure of involuntary muscular fibre. Transactions of The Microscopical Society & Journal, 1858 Jan; 6(1):5-14.
• On spontaneous gangrene from arteritis and the causes of coagulation of the blood in diseases of the blood-vessels. Edinburgh Medical Journal, 1858 Apr; 3(10):893-907.
• On the coagulation of the blood : the Croonian lecture delivered before the Royal Society of London, 11th June 1863. London : Taylor and Francis, 1863.
• On a new method of treating compound fracture, abcess etc.; with observations on the conditions of suppuration. The Lancet, 1867 Mar 16; 89(2272):326-329.
• Introductory lecture delivered in the University of Edinburgh, November 8, 1869. Edinburgh : Edmonston and Douglas, 1869.
• Observations on ligature of arteries on the antiseptic system. Edinburgh : Edmonston & Douglas, 1869.
• Remarks on a case of compound dislocation of the ankle with other injuries : illustrating the antiseptic system of treatment. Edinburgh : Edmonston & Douglas, 1870.
• On the effects of the antiseptic system of treatment upon the salubrity of a single hospital. Edinburgh : Edmonston & Douglas, 1870.
• A further contribution to the natural history of bacteria and the germ theory of fermentative changes. London: Printed by J.E. Adlard, 1873.
• An Address on the Antiseptic Management of Wounds Delivered at King's College Hospital in the London Post-Graduate Course, January 18th, 1893. British Medical Journal, 1893 Feb 18; 1(1677):337–339.

In a series of two blog posts published this February around the anniversary of Lister's death (10 February 1927), we explore the Joseph Lister Archive and Library collections at The Royal College of Surgeons. In addition to this article on library holdings, you might like to read our article on archive holdings.

Corinne Hogan, Assistant Librarian.