As luck would have it, Professor Pirrie—whose name Simpson had invoked in defense of acupressure—published an article in The Lancet on the very day that Lister’s final response appeared in the journal. Specifically, he praised the virtues of carbolic acid for treating burns and predicted that if Lister’s antiseptic method was equally useful in treating other ailments, “it would be a great blessing in the treatment of these dangerous and painful injuries.” Nowhere in the article did he mention acupressure. For the moment, Simpson fell quiet.
Although publicly Lister maintained a dignified silence, privately he felt wounded by the attacks. In a letter to Joseph Jackson, he wrote, “I have always felt that for the editors of these medical journals to take no notice at all of any articles I might write was the best that could happen; so that the good, if there was any, in my work might quietly produce its effect in improving the knowledge and treatment of disease.” He added, mournfully, “Fame is no plant that grows on mortal soil.” Lister’s nephew said of his uncle that he found Simpson’s attacks repugnant and distressing. The quiet, reserved surgeon—who once thought the Scottish cities would suit his temperament better than London because there were far fewer professional quarrels—was beginning to realize how difficult the task ahead would be. He would need more than the testimony of a few medical students to encourage surgeons to take his antiseptic treatment seriously.
* * *
Many opponents likened Lister’s antiseptic system to the traditional practice of putting ointments on putrefactive wounds and hoping for the best—like those practitioners who had been using wine, quinine, and Condy’s fluid for decades. A young physician from Liverpool named Frederick W. Ricketts sided with Simpson, arguing that acupressure was “simple, effectual, and elegant,” while Lister’s methods were “obsolete and inelegant.” In a similar way, James Morton, a physician who had worked with Lister at the Royal Infirmary until his tenure ended in October 1867, concluded that carbolic acid was “certainly not superior, barely equal, to some of the other antiseptics in common use.” Like Ricketts, Morton thought that Lister’s methods were outdated and took issue with their being called a “system” of treatment. Instead, he characterized them as “an antiseptic mode of dressing”—one of many already in existence—and thought Lister had “allowed his pen to run probably a little too fast” when praising his own results.
While the older generation of surgeons were willing to try his antiseptic treatment on patients, they struggled to accept the germ theory of putrefaction, which was at the heart of his system. If surgeons continued to misunderstand the cause of infection, they were unlikely to apply his treatment correctly. In the midst of this debate, Lister presented an address to the Medico-Chirurgical Society of Glasgow in which he emphasized that efforts in employing the antiseptic treatment should be directed on sound principles, namely, Louis Pasteur’s.
Lister’s colleague Morton didn’t just find fault with his methods. He also didn’t accept the premise that germs were to blame for putrefaction. Morton characterized Lister’s published research as fearmongering. “Nature is here regarded as some murderous hag,” he wrote, “whose fiendish machinations must be counteracted. She must be entrapped into good behavior, she is no longer to be trusted.” Even the editor of The Lancet refused to use the word “germs,” instead calling them “septic elements contained in the air.” It was difficult for many surgeons at the height of their careers to face the fact that for the past fifteen or twenty years they might have been inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures.
There were practical problems with Lister’s antiseptic treatment as well. His methods were considered overly complicated, and they were constantly evolving. Even if surgeons accepted that germs were the culprit, many of them were unable or unwilling to follow his methodology with the level of precision needed to achieve the promised results. They had been trained by a generation of surgeons who valued speed and practicality over exactitude. “Mr. Rouse has occasionally sponged the wound, in the operating theatre, before applying the sutures, but not having found any advantage arise from it, he has discontinued the practice,” one report read. Similarly, Mr. Holmes Coote “does not approve of Lister’s method, which he considers meddlesome.” Another surgeon reported that Lister’s antiseptic treatment was sufficient to destroy putrefaction once it had set in, but it was not good as a preventive measure: “Yet in regard to its antipurulent properties such satisfactory results have not been obtained.”
The illustrious surgeon James Paget had also experienced mixed results using Lister’s antiseptic treatment in London. In his first published article about it, he conceded that he might have been applying the system incorrectly. Within a short period, however, Paget rejected Lister’s system altogether, stating that it was dangerous, especially in cases where carbolic acid was left on the wound too long. This time around, Paget claimed, he had followed each step carefully, “if not with all the skill that Professor Lister would employ it, yet with more than is ever likely to be generally used in the treatment of fractures.” Lister’s antiseptic treatment “certainly did no good,” in Paget’s opinion.
Given his prominence in the medical community, Paget’s testimony was damning. It wasn’t a surprise that the greatest resistance to Lister’s antiseptic treatment had come from the capital. As verdict after verdict against Lister rolled in, the editor of The Lancet wondered why London seemed to be especially resistant to his methods. “Are the conditions of suppuration different here from those in Glasgow?” he asked facetiously. “Or is it that the antiseptic treatment is not tried with that care without which Mr. Lister has always pointed out it does not succeed?” As long as others were applying his methods shoddily or halfheartedly, winning hearts and minds would prove next to impossible. Lister needed to go with a more proactive approach.
10.
THE GLASS GARDEN
New opinions are always suspected, and usually opposed, without any other reason but because they are not already common.
—JOHN LOCKE
JAMES SYME CAUGHT HIS ASSISTANT giving him a peculiar look from across the room. Thomas Annandale had been watching him closely all morning while he examined patients in his consultation room at Shandwick Place, and it was beginning to grate on his nerves. The last two months had been tough on the old surgeon, and he was feeling out of sorts. It was the spring of 1869, and Syme was nearly seventy years old. His wife, Jemima, had died unexpectedly in February, leaving an empty space in his heart and his home. Joseph Jackson—himself a widower—wrote to his son upon hearing the news: “I have truly felt for thy estimable father-in-law under his bereavement and the desolation he must feel at home.” Millbank House just wasn’t the same without Jemima’s comforting presence.
Syme knew that his friends and his family were worried about him. But on this particular morning, he felt that Annandale’s concern was more specific. An hour earlier, Syme felt his mouth twist slightly as he was speaking to a patient, and his hand shook as he scribbled out a prescription. Still, he didn’t think much of it. Perhaps his stutter had momentarily returned, or maybe it was age related. Whatever the cause, though, Annandale was beginning to make him feel uneasy, and he decided to put a stop to it. In case the young man thought he hadn’t noticed the little episode, Syme announced in a loud, distinct voice, “What a curious nervous feeling I had just now; I felt as if I wanted to speak and could not.”
As the day wore on, Syme performed several operations around the city. All the while, he could feel Annandale’s eyes boring into him. The younger surgeon positioned himself at Syme’s side during each procedure. “Although I was anxiously watching every step,” Annandale later said, “I could detect nothing in Mr. Syme’s actions [during the operations] … out of the common.” And yet his assistant couldn’t shake the feeling that something wasn’t quite right.
The two men returned to the private clinic at Shandwick Place late that afternoon. Sym
e’s son and niece were waiting for him in his consultation room when he arrived, and he was given temporary reprieve from Annandale’s critical gaze while he spoke privately with his family. After a brief but pleasant conversation, Syme ushered them out in anticipation of the arrival of his next patient. As he shut the door to his office, he noticed his assistant approach his family to speak with them quietly in the hallway.
A few minutes later, a loud crash rang out as Syme collapsed onto the floor.
* * *
Syme had suffered a paralytic stroke, and although he retained the ability to speak, he had lost the use of the left side of his body. The situation appeared grim, but those around him were optimistic. The elderly surgeon had recovered from a stroke a year earlier. Everyone assumed the outcome would be the same the second time around. The Lancet broke the news to the medical world, stating that the attack was not severe and “strong hopes are entertained of a complete recovery.” A few weeks later, The Lancet again reported on Syme’s health. He had regained movement in his hand and was now able to walk around his garden. “We only echo the feeling of the whole profession,” the article continued, “when we express the wish that Mr. Syme may long be spared, if not to operate with his rare skill, at any rate to contribute his clearly defined opinions on those professional questions in regard to which his large experience and shrewd judgment make him an authority.”
Lister and his wife traveled to Edinburgh to be with Syme while he convalesced. Agnes shared nursing duties with her younger sister Lucy, and slowly but surely, Syme began to recover. But the elder surgeon soon recognized his own limitations. That summer, he resigned his position as chair of clinical surgery at the University of Edinburgh with the hope that Lister would take his place. Shortly after, 127 medical students at the university wrote to Lister, imploring him to accept the position. “We take this step from a conviction that you are the man most capable,” they wrote, “from your high attainments and achievements in Surgery, to maintain the dignity and renown which have been conferred upon the Chair and the University by Mr. Syme.” They praised Lister for his contributions to science and for his recent research with carbolic acid: “Your method of Antiseptic Treatment constitutes a well-marked epoch in the history of British Surgery, and will result in lasting glory to the Profession, and unspeakable benefit to mankind.” Lister needed no further persuasion. On August 18, 1869, he was elected to the chair of clinical surgery at the University of Edinburgh.
It was a felicitous return, albeit one that happened under tragic circumstances. One of Syme’s friends wrote to Lister that it was a “great happiness to all—especially Mr. Syme, who I think would not have cared to live had the worst been taken and the best lost.” The Lancet lauded the appointment, though the editors of the journal were careful not to endorse Lister’s antiseptic treatment: “We have throughout strongly supported the candidature of Mr. Lister.… Even if the hopes which have been raised in connection with his antiseptic labours have to be qualified, he is well calculated to raise the scientific character of surgery.”
The following month, Lister and Agnes moved back to Edinburgh. They took up temporary lodgings at 17 Abercromby Place before moving to a lavish house at 9 Charlotte Square. The house had once belonged to Syme before he moved to Millbank, and although committing to the property involved an enormous sum of money, Lister could afford it. He had come a long way since his days as a house surgeon.
* * *
Meanwhile, the ridicule of Lister’s antiseptic system continued to grow. Many within the medical community tried to paint him as a pretentious charlatan whose ideas were foolish at best, dangerous at worst. At University College Hospital in London, the surgeon John Marshall railed against the antiseptic treatment after observing green urine in a woman who had undergone a mastectomy. Similar reports followed. These surprised Lister. He was already aware of the perils of carbolic acid poisoning, having witnessed the results of it firsthand, and years earlier had warned doctors to dilute the solution. He was certain that this was just another example of his methods failing because others were careless in how they employed them.
One of the more critical voices was that of Donald Campbell Black, a surgeon from Glasgow, who called Lister’s antiseptic treatment “the latest toy of medical science.” He thought Lister’s results were due to coincidences and warned against what he called the “carbolic acid mania.” He wrote that there was “nothing more opposed to the true progress of scientific medicine or surgery” than the “mounting hobbies” of surgeons like Lister. What’s more, Black questioned whether there had actually been an improvement at the Royal Infirmary. He had acquired statistics from The Medical Times and Gazette that suggested there had been no change in mortality rates from amputations and compound fractures in Lister’s hospital in an eight-year period.
From 1860 to 1862, one-third of those who underwent amputation died. One-fourth of those who suffered compound fractures but did not undergo amputation also died. There were similar mortality rates for 1867 and 1868, when Lister’s antiseptic system had been introduced into the hospital. Indeed, there was a slight increase in the number of patients who died from amputations, though these statistics were misleading because they represented the total deaths throughout the entire hospital. Not every surgeon at the Glasgow Royal Infirmary had adopted Lister’s techniques. Even among those who accepted his methods, many did not execute them with the precision and consistency needed to produce the promised results. Lister would need to distinguish his own successes from those of other surgeons within the same hospital in the future in order to address this type of discrepancy.
Those who did accept Lister’s results still harbored doubts over the actual reasons behind the decline in mortality rates. Several doctors claimed that his success was due to overall improvements in hygiene in the new surgical building at the hospital—not just to his antiseptic system. Lister fought back: “To suppose that the kind of change which I have described as having taken place in the salubrity of my wards can be attributed to the causes referred to, is simply out of the question.” He reiterated that his wards had been among the most unhealthy at Glasgow’s Royal Infirmary before he began employing carbolic acid, going as far as to say it was a “questionable privilege to be connected with the institution.” The blame, he believed, lay squarely with the hospital managers, the same ones who had blocked his appointment to the Royal Infirmary when he first moved to Glasgow. Lister wrote, “I engaged in a perpetual contest with the managing body, who, anxious to provide hospital accommodation for the increasing population of Glasgow … were disposed to introduce additional beds.” Although the managers had removed a high wall on the wards to improve air circulation, this had occurred after he had been treating patients with carbolic acid for nine months. Therefore, Lister believed this could not have accounted for the decline in mortality rates on his wards. As to those people who attributed his success to improved diets and increased rations on his wards, Lister wrote that the idea that diet alone could abolish pyemia, erysipelas, and hospital gangrene “would hardly enter the mind of an intelligent medical man.”
Lister’s remarks about the state of Glasgow’s Royal Infirmary did not go unnoticed by its hospital managers, many of whom already harbored disdain for the trailblazing surgeon. Henry Lamond, secretary to the directors, was quick to respond. Writing to the editor of The Lancet, Lamond said that Lister’s accusations “so far as they relate to the alleged unhealthiness and condition of the hospital … are unfair and not supported by facts.” The administrators believed that Lister’s antiseptic treatment had contributed very little to declining mortality rates at the hospital in recent years. Instead, they maintained that “the improved health and satisfactory condition of the hospital, which has been as marked in the medical as in the surgical department, is mainly attributable to the better ventilation, the improved dietary, and the excellent nursing to which the Directors have given so much attention of late years.”
The most
publicly damning critique came from Thomas Nunneley, an English surgeon in Leeds who took great pride in having not permitted a single patient of his to be treated with carbolic acid. In his address to the British Medical Association in 1869, he said that Lister’s antiseptic system was based on “unsupported fancies, which have little other existence than what is found in the imagination of those who believe in them.” He thought that Lister’s advocacy of the germ theory was preposterous: “This speculation of organic germs is, I fear, far more than an innocent fallacy,” he told conference attendees, among them James Y. Simpson. “It is a positive injury,” he continued, “for teaching … that those desperate consequences which so often follow wounds result from one cause alone, and are to be prevented by attending to it alone … leads to the ignoring of those many and often complicated causes.”
In his response to Nunneley, Lister could barely disguise his disgust: “That he should dogmatically oppose a treatment which he so little understands; and which, by his own admission, he has never tried, is a matter of small moment.” Sensing his son’s growing frustration over the attacks, Joseph Jackson sought to comfort him. In a letter, he wrote, “However slowly & imperfectly the improvements suggested by thee may be adopted & however thy claims may be slighted or disputed, it is a great thing to have been permitted to be the means of introducing so great a blessing as the antiseptic Treatment to thy fellow mortals.”
* * *
While Lister was fighting a war of words with skeptics, troubling news arrived from his family again. A few weeks after he moved to Edinburgh, he received a message from his brother Arthur, who had recently paid a visit to Upton to see their father. Arthur confessed that he had not been “prepared to see so great a change in dear Papa.” Joseph Jackson was so weak that he barely had the strength to turn over in bed. Their father was now eighty-three years old, and while he had always been a robust man, Lister had started to notice small changes in Joseph Jackson over the last several years. He had suffered from a severe cough a few months earlier, and in one of his last letters to Lister he complained about a skin infection on his ankle. Even more telling was the fact that his father’s once clear copperplate handwriting had become increasingly illegible—a sure sign that the octogenarian’s coordination was beginning to fail him, just as Syme’s had after the stroke.
The Butchering Art Page 18
