* * *
BACK IN EDINBURGH, John Rudd Leeson had only recently qualified as a surgeon when he approached the home of Joseph Lister. The man was visibly nervous. The house itself was “like a moat which made Lister still more inaccessible” than he already seemed to Leeson as he climbed the broad steps to the front door. He had come to ask the renowned professor if he could put his name on a wait list to become one of his surgical dressers at the hospital. Although Leeson had attended Lister’s wards, he had yet to speak directly to the man whom he had come to admire so much.
The butler—a stern man whose demeanor had earned him the nickname “Mr. Bludgeon”—ushered Leeson into the private study where Lister was sitting before shutting the door behind him. The young surgeon found himself in a stately room dominated by glass-fronted mahogany bookcases and large north-facing windows. Lister stood up from behind his desk to greet Leeson, who “felt instinctively that I was in the presence of … the embodiment of high purpose.” The elder surgeon put the novice at ease with what Leeson described as a “delightful and charming smile.” After a brief conversation, Lister reached for a small ledger from one of the drawers in his desk and entered the man’s name in its pages. He told Leeson that he could commence work as his surgical dresser the next winter.
As Leeson turned to leave, he noticed something odd on a table in front of the windows. Glittering in the sunlight and covered with glass shades were several rows of test tubes, half full of various liquids and plugged with cotton wool: Lister’s Glass Garden. “It was a curious assemblage such as I had never seen, nor could I form the least conjecture as to what they were or why they should be plugged with cotton,” he later wrote. “My experience of test-tubes was an open mouth and I never remember having seen them closed.”
Seeing a sudden interest in the young surgeon’s face, Lister rushed to his side, delighted to show Leeson his odd collection of liquids. He pointed out that some were turbid and moldy while others remained clear. “I tried to show an intelligent interest,” Leeson confessed, “but had not the faintest idea as to what it was all about.” As the professor pontificated about his most recent experiments into the causes of putrefaction, Leeson marveled that the renowned surgeon should have time to pursue such irrelevant and out-of-the-way matters.
Hoping to end the encounter on a high note, Leeson cast around for a subject on which he could speak coherently. That was when his eyes fell upon the large Powell and Lealand microscope sitting on Lister’s desk. He told the professor that the revered octogenarian demonstrator at St. Thomas’ Hospital in London who had taught him anatomy had used a similar instrument. Lister’s eyes sparkled with excitement: mentioning the microscope “seemed to bring [him] back to reality.” He chatted eagerly with Leeson about the importance of the instrument for the future of surgery.
“I had not the least idea that [the microscope] had any connection with the plugged test-tubes,” Leeson later admitted. Although he had spent two and a half years at one of London’s largest and most progressive hospitals, the newly qualified surgeon said that he had “never heard anything about microbes … and certainly had not the slightest idea that they had connection with medicine or surgery.” The role of scientific knowledge and methodology in medical practice—which was central to the transition of the profession from a butchering art to a forward-looking discipline—had not yet been established. But the tide was turning in Lister’s favor.
11.
THE QUEEN’S ABSCESS
Truth from his lips prevailed with double sway,
And fools, who came to scoff, remained to pray.
—OLIVER GOLDSMITH
LISTER’S CARRIAGE PULLED UP at the grand entrance of Balmoral Castle, the heart of Queen Victoria’s sprawling estate in the Highlands of Scotland, on September 4, 1871. The day before, he had received an urgent telegraph requesting his presence at this royal residence. The queen was gravely ill. An abscess in her armpit had grown to the size of an orange, already measuring six inches in diameter. With Syme dead, Lister was now the most renowned surgeon in Scotland, so it was only natural that he would be consulted on a serious matter involving the queen’s health.
Victoria’s troubles had begun a few weeks earlier, when she developed a sore throat. Soon after, she experienced pain and swelling in her right arm. In a diary entry a short while later, the queen bemoaned the fact that her “arm [is] no better, & will not yield to any treatment. Every kind of thing has been tried.” Her physicians begged the queen to allow a surgeon to be brought in. Not recognizing the severity of the situation, she demurred, but promised to think the matter over. Several days later, as the pain reached an excruciating level, Victoria finally consented.
* * *
The scrupulous surgeon carried everything with him that he would need to operate, including his latest invention: the carbolic spray. The idea for the apparatus had come to Lister a few months earlier and was, in part, prompted by a series of experiments carried out by the British physicist John Tyndall. By passing a concentrated ray of light through the air, Tyndall demonstrated the high content of dust floating in the atmosphere. He noticed that when the air was free from particles, however, the light disappeared. Tyndall rendered a sample of air dust-free with the use of heat and showed that putrescible solutions exposed to it remained sterile, while contact with air containing dust was soon corrupted by bacteria and mold. He spoke in amazement of the number of particles in the air “churning … in our lungs every hour and minute of our lives” and expressed concern over the effects they might have on surgical instruments in particular. For Lister, this merely reinforced the idea that germs in the air needed to be destroyed in medical environments. The carbolic spray was therefore designed to sterilize the air around the patient, both during an operation and afterward when changing dressings. But it had another purpose as well. Lister believed that the spray would reduce the need for direct irrigation of the wound with carbolic acid, which often damaged the skin and increased the risk of inflammation and infection.
At first, the apparatus was a handheld device, but like all of Lister’s innovations it underwent several alterations during his lifetime. In one of its later forms—dubbed the “donkey engine”—a large copper atomizer sat on a tripod about three feet high. There was a foot-long handle on the atomizer that could be used to direct the spray. The entire mechanism weighed nearly ten pounds and was a cumbersome instrument that needed to be carried in with the help of Lister’s assistants, who each took a turn working the apparatus during long hours in the operating theater. One of Lister’s former students wrote that the “citizens of Edinburgh grew used to the sight of [him] driving through the streets, uncomfortably sharing the accommodation in his brougham with this formidable engine of his warfare.”
As comical as the mechanism was, the use of carbolic spray was a significant moment in medical history. Before then, critics could point to Lister’s treatment as an extension of traditional methods that involved cleaning wounds with some form of an antiseptic. The atomizer, however, signaled Lister’s commitment to the germ theory, specifically the one put forward by Louis Pasteur. At this point, little work had been done in the way of differentiating one kind of bacterium from another, much less distinguishing between pathogenic and harmless bacteria. It was only decades later that Lister abandoned the carbolic spray when the German physician and microbiologist Robert Koch developed a technique for staining and growing bacteria in a Petri dish (named after his assistant Julius Petri). This enabled Koch to match particular microorganisms to specific diseases and advance the theory that bacteria exist as distinct species, each producing a unique clinical syndrome. Using his method, Koch showed that airborne pathogens were not the main culprit of wound infection, which meant that sterilizing the air was futile.
In 1871, however, Lister was very much committed to the technique, and so he brought the carbolic spray with him when he was called to the bedside of the queen. As Lister entered Victoria’s grand bedchambe
r in Balmoral Castle, he was confident that his antiseptic system saved lives. Still, using carbolic acid on hospital patients, or even his own sister, was very different from using it to treat a queen. His reputation would be ruined if his actions caused lasting harm to the monarch. Lister must have felt considerable trepidation when he examined Victoria and recognized that the situation was now critical. If the abscess grew worse, any number of septic conditions might set in, and the queen could die.
Victoria reluctantly gave her permission for the operation to proceed. Writing in her diary later, she confessed, “I felt dreadfully nervous, as I bear pain so badly. I shall be given chloroform, but not very much, as I am so far from well.” In fact, she would remain semi-alert throughout the operation because Lister decided not to administer a heavy dose of the anesthetic on account of the queen’s perilous state of health.
Lister called upon the help of the royal physician, William Jenner, whom he entrusted with the task of operating the carbolic spray during the procedure. As Lister began disinfecting his instruments, his hands, and the affected area under the queen’s arm, Jenner pumped mists of carbolic acid into the air, filling the room with its distinctive aroma of sweet tar. When he was satisfied that sufficient quantities of the antiseptic were saturating the immediate area, Lister made a deep incision into Victoria’s abscess. Blood and pus gushed from the wound. Lister carefully cleansed the cut, while Jenner continued with his energetic pumping of carbolic acid, covering everyone in the vicinity with white clouds of the corrosive substance. At one point, the royal physician fumbled with the awkward contraption and accidentally sprayed the queen in the face. When she complained, Jenner half jokingly replied that he was only the man who worked the bellows. Once the procedure was over, Lister carefully bandaged the wound and left the exhausted monarch to rest.
The next day, as Lister was changing Victoria’s dressings, he noticed that pus had formed underneath the linen that he had placed over the surgical wound. Lister needed to act quickly to prevent infection from setting in. Spying the atomizer, he had an idea. He took the rubber tubing off the apparatus, soaked it overnight in carbolic acid, and inserted it into the wound the following morning in order to drain the pus. The following day, Lister’s nephew wrote that his uncle “rejoiced to find nothing escape [from the wound] unless it were a drop or so of clear serum.” Lister himself later claimed that this was the first time he used such a drain. His ingenious ad hoc invention, along with his application of antiseptic methods, undoubtedly saved Victoria’s life. One week later, Lister left Balmoral Castle and returned to Edinburgh, satisfied with the queen’s recovery.
Back in the classroom, he quipped to his students, “Gentlemen, I am the only man who has ever stuck a knife into the Queen!”
* * *
News of Joseph Lister’s successful treatment of Victoria spread, bolstering faith in his methods. The queen had given Lister’s antiseptic system the royal stamp of approval simply by allowing him to operate on her. Furthermore, James Y. Simpson had died from a heart condition, putting an end to the feud that had blighted Lister’s work for several years.
Shortly after Lister’s encounter with royalty, Louis Pasteur traveled to London. On that trip, John Tyndall—who had recently visited Lister’s wards in Glasgow—casually mentioned to the French scientist that “a celebrated English surgeon” had made an important contribution toward understanding the causes of putrid and contagious diseases using Pasteur’s work as a guide. This was the first time Pasteur had ever heard of Lister. His interest was piqued.
The two men began a lengthy correspondence. In their letters, they discussed their experiments, theories, and discoveries and expressed mutual respect and esteem. Lister saw Pasteur as the man who had provided the means by which he could understand wound sepsis. In turn, Pasteur was in awe of Lister’s advancement of the subject. As Pasteur wrote, “I am extremely surprised at the precision of your manipulations, [and] at your perfect comprehension of the experimental method.” He was amazed that Lister could find the time to conduct such complex research while also attending to his patients. “It is a perfect enigma to me,” he wrote to Lister, “that you can devote yourself to researches which demand so much care, time and incessant painstaking, at the same time as you devote yourself to the profession of surgery and to that of chief surgeon to a great hospital. I do not think that another instance of such a prodigy could be found amongst us here.” To Lister—a man who had always placed immense faith in the scientific method—this was as high a compliment as could be paid him, especially since it came from such a revered figure as Pasteur.
As his own fame spread, Lister’s classrooms swelled with students and eminent visitors from all over the world who had come to Edinburgh to witness the surgeon in action. He traveled around the country, expounding the virtues of his antiseptic system to medical audiences. And heartening reports finally began to emerge from London. The Lancet’s call to action had worked: hospitals in the capital were once again testing the efficacy of the antiseptic system. This time, the results were more encouraging than they had been at the end of the 1860s, shortly after Lister first published his findings. St. George’s Hospital announced a rise in confidence in Lister’s methods among its staff. Middlesex Hospital expressed similar sentiments after attaining positive results with both carbolic acid and zinc chloride. But the strongest support came from London Hospital, where nearly fifty surgical procedures performed in the past year were “conspicuous for the small amount of constitutional disturbance produced by very severe injuries” after surgeons began employing the antiseptic system.
Although there had been a perceptible shift in opinion toward the acceptance of Lister’s methods in the capital, it took several more years before the wholesale adoption of antisepsis occurred in London. This was largely due to the fact that many surgeons in the city were unwilling to endorse Pasteur’s germ theory of putrefaction. One London surgeon mocked Lister and his pioneering work by closing the door of his operating theater with a loud bang in order to “shut out Mr. Lister’s germs.” In a letter that appeared in The Lancet, a correspondent who signed his name “Flaneur” made a perceptive observation regarding the city’s slow adoption of antisepsis:
The truth is, that this is a question in science rather than in surgery, and hence, while eagerly adopted by the scientific Germans, and a little grudgingly by the semi-scientific Scotch, the antiseptic doctrine has never been in any degree appreciated or understood by the plodding and practical English surgeon. Happily for his patients, he has for a long time been to a considerable extent practising a partially antiseptic system, thanks to his cleanly English instincts; but it has been like the lady who talked prose without knowing it.
It was easier for Lister to convince doctors in Glasgow and Edinburgh of the value of his antiseptic system because each of those cities had one hospital and one university at its heart. London’s medical community was far more fragmented and less scientifically minded. Clinical teaching was not yet as common in the capital as it was in Scotland. Lister railed, “If I turn to London, and ask how instruction in clinical surgery is conducted there, I find that not only according to my own experience as a London student … but also from the universal testimony of foreigners who visit there and then come here, it is, when compared with our system here, a mere sham.” These were obstacles Lister could not overcome unless he could reform the system from within.
There was one group who never doubted Lister’s antiseptic treatment: the people who survived because of it. An elderly man who had been admitted to the hospital both before and after Lister had introduced his system onto the wards remarked on the differences he saw: “Man, but ye hae made a grand improvement since I was here afore.” Even those outside the profession who had not been Lister’s patients were getting wind of miraculous recoveries. In a letter to her sister-in-law, Agnes Lister recounted the story of a boy whose life had been saved with carbolic acid after he had been severely burned while working
in a local foundry. Patrick Heron Watson—who was once Lister’s house surgeon—met with the Listers on the day of the accident. He told the couple that “he did not think that the boy could recover,” Agnes wrote, “but by the help of carbolic acid, he is recovering and the case has excited great interest in several foundries.” In fact, deputations of workmen came to the hospital to see the boy for themselves. Agnes wrote that “the boy’s masters will appoint Dr. Watson surgeon to their works which will give him a salary of £300 a year” as a result. Another house surgeon who worked with Lister later wrote, “If recognition on the part of his colleagues was slow in coming, patients who had had experience under both systems, the old and the new, were quick to perceive the difference.”
* * *
Lister’s fame abroad was underscored in 1875, during a much-feted European tour he undertook with Agnes to showcase his methods. Wards adhering to his system were celebrated by many for their “fresh, healthy atmosphere” and an “absence of any smell,” while The Lancet characterized his progress through the university towns of Germany, where his system was particularly popular, as a triumphal march. Still, one nation remained unconvinced of the merits of Lister’s methods: the United States.
In fact, in several American hospitals, Lister’s techniques had been banned; many doctors saw them as unnecessary and overly complicated distractions because they had not yet accepted the germ theory of putrefaction. Even by the mid-1870s, understanding of wound care and infection had barely progressed, despite Lister’s theories and techniques appearing in American medical journals. The medical community had, for the most part, rejected his antiseptic methods as quackery. Transatlantic skepticism notwithstanding, in 1876 Joseph Lister turned his eyes west when he was invited to defend his methods at the International Medical Congress in Philadelphia. To bring about a change in American attitudes, Lister knew he would need to evangelize for his work in person. As it turned out, convincing the Americans of the merits of antisepsis would not be as straightforward as he hoped.
The Butchering Art Page 20
