Joseph Lister's domestic science

In the spring of 1847, John Phillips Potter, a young Demonstrator of Anatomy at University College Hospital, in London, UK, sustained a knuckle scratch during the dissection of an infected corpse. Although at the time he thought little of it, the infection spread inexorably. Despite intermittent signs of recovery during the next 3 weeks, he died of sepsis on May 17, 1847. The Lancet commented: “…the concourse of students and fellow teachers which followed him to his early grave, the omission of the annual college festival, and the meeting to erect a monument to his memory, are incidents grateful in themselves, and reflecting the highest honour upon University College…The victims of dissection ought to hold a distinguished place among the martyrs to science and knowledge. We can deliver our artizans of the mine and the loom and the wheel, from many of the dangers incident to their callings, but our art has failed, hitherto, of delivering our own workers from this destructive poison.” Joseph Lister had been taught by this young man, and is likely to have been among the 200 staff and students at Kensal Green Cemetery. Potter is said to have been lively, brilliant, an excellent teacher, and a man of fine promise, greatly liked by the students. It is not known if his death contributed towards Lister's nervous breakdown later that year, after a bout of smallpox and his first term as a full-time medical student. At any event, Lister took more than a year out, and did not resume his studies until the autumn of 1849. Famous today as the originator of antiseptic surgery, the lifelong study of microscopy upon which Lister's surgical innovations depended tends to be overlaid by the greater claim to fame. He was a second-stage rocket: his father, Joseph Jackson Lister, a prosperous Quaker wine-merchant, of the Essex village of Upton, on the margins of London, was the inventor of the achromatic lens, said to have transformed the microscope from a scientific toy to a serious tool of discovery. For this important work he was elected a Fellow of the Royal Society. In the mid-1820s Thomas Hodgkin, of Guy's Hospital, had worked with Lister senior using these new lenses to visualise clearly the biconcave structure of red blood cells, the minute striations of voluntary muscle, and the fat globules of milk. Their coauthored paper describing what the new lenses had revealed was published in 1827 in the Philosophical Magazine, shortly after Joseph Lister was born. He grew up in a household where the teeming life of the very small was a favourite topic of conversation, observation, and connection. Lister's upbringing was comfortable, but modest. His sole extravagance as a student seems to have been alms-giving to London street beggars. Following Hodgkin's recommendation, Lister avoided apprenticeship as an apothecary or surgeon before attending medical school, and instead studied for an arts degree at University College London between 1844 and 1847, gaining a first at finals. During his last undergraduate year, Lister also registered to study anatomy in the medical school. In December, 1846, he was present in the operating room in Gower Street when the celebrated University College surgeon Robert Liston undertook the first surgical operation in Europe under ether anaesthesia. Lister witnessed the highs and lows of mid-Victorian surgery even as a student: John Potter died the following May; had he survived, he would have been Liston's assistant-surgeon. Returning in the autumn of 1849, Lister brought with him a gift from his father: a better microscope than any man in the College. A star pupil at medical school, Lister won gold medals and honours in several subjects, and gained his first MB with honours in 1850. He did not become an anatomical demonstrator. Despite health concerns which delayed things, he took on the role of surgical dresser to John Erichsen at University College Hospital in January, 1851, and had barely started in the post when there was an epidemic of erysipelas on Erichsen's male surgical ward. The epidemic originated from a patient taken in from the Islington workhouse, suffering from mortification of both legs. The hospital had been free of infection for some time, due to a policy of swift isolation in such cases, but this poor man was given a bed in the surgical ward for 2 hours, until Erichsen's daily ward-round. Despite isolating the patient immediately diagnosis was made, the man in the next bed—who had been recovering well from an operation for iliac and lumbar abscess—went down with the infection and died. Within days there were 12 cases of infection and five deaths (including the workhouse patient) most from exhaustion after distressing vomiting and diarrhoea. Erichsen subsequently urged the wisdom of isolation facilities with specific staff in such epidemics. The disease, he emphasised, was a form of surgical fever—not merely cutaneous, but constitutional—and he particularly noted that while all patients with recent operation wounds were swiftly affected, those with older suppurating wounds in the same ward “mostly escaped”. There can be no doubt that in 1851 young Lister was using his microscope to search for the causes of this terrible disease. Although the texts of two talks he gave that year to the Students' Medical Society have not survived, their topics—Hospital Gangrene and The Microscope—demonstrate his reaction to these events. Late in life he mentioned that he had thought at that stage to have seen something: “I imagined they might be the materies morbi in the form of some kind of fungus”. Reading through Lister's later classic papers on antiseptic surgery, germ theory, inflammation, blood coagulation, pus and suppuration, wound care, suturing, and fracture-healing, one can sense their deep roots. They are the results of experience meditated upon at length, in the midst of an active clinical life. Alongside his assiduous work in the operating theatre and on the wards—in Glasgow, Edinburgh, and from 1877 back in London—his commonplace books attest to a private life spent in the laboratory. Lister's marriage seems to have been extremely happy. Agnes, his wife, daughter of the Edinburgh surgeon James Syme, was Lister's partner in everything. Watson Cheyne, Lister's student, friend, and biographer—almost their surrogate son—said after Lister's death that Agnes had entered into his work wholeheartedly, had been his only secretary, and that they discussed his work “on an almost equal footing”. Lister was left bereft when she died unexpectedly from pneumonia while they were holidaying abroad after his retirement from King's College London in 1893. His huge commonplace books are full of her handwriting, page upon page of careful notes taken at his dictation, for hours at a stretch. Going by the volume of domestic laboratory work recorded—such as the sterilising of equipment, the repeated monitoring of oven temperatures, the care of experimental animals, and so on—it is clear that Agnes was his coworker. The evolution of the thoughtful technique that underpinned Lister's extraordinary surgical advances and bacteriological work was elaborated at home. What might have started out as a workbench for his microscope evidently ended up as a dedicated apartment, with its own plumbing and gas supply for Bunsen burners, a purpose-built autoclave (Lister called it a “hot box”), and laboratory cupboards full of equipment, with special arrangements to preserve the purity of sterile equipment, bacterial cultures, and ongoing experiments. On many occasions it seems this work was being pursued after his working day with both Lister and Agnes present, he observing and dictating, she writing. In Lister's most productive years, the break from teaching at the end of the medical school year in early summer was the occasion for periods of detailed experimentation. Spaces were left blank among the screeds of handwriting for the later insertion of small drawings Lister habitually made using a camera lucida attached to his microscope, his micrometer scale always recorded alongside, and invariably also date, time, and the experimental series to which the image belonged. It probably fell to Agnes to trim and paste these tiny drawings appropriately while Lister was busy elsewhere. It was during these years of devoted work that Lister eventually confirmed Louis Pasteur's work on fermentation as the key to what we would call infection. At his inaugural lecture at King's College London in 1877, Lister showed the first ever pure bacterial culture, obtained by his own process of serial dilution, demonstrating the extraordinary proof that a single bacterium was sufficient to do the work. 30 years after Potter's tragic death, Lister was finally able to explain how only a needle's point of living bacterial matter could contaminate a sterile test-tube of fresh blood or fresh milk: and by implication, an entire human body. Joseph Lister's 1877 Inaugural Lecture is being restaged at King's College London, UK, on Oct 2, 2013. See http://www.kcl.ac.uk/medicine/newsevents/eventrecords/2013/Oct/Lister.aspx Joseph Lister's 1877 Inaugural Lecture is being restaged at King's College London, UK, on Oct 2, 2013. See http://www.kcl.ac.uk/medicine/newsevents/eventrecords/2013/Oct/Lister.aspx