* * *
Five years after operating on the queen, Lister was ready to face his critics in America. In July 1876, he boarded the SS Scythia—the last of the famous Cunarders with full sail and steam capabilities—for its voyage from Liverpool to New York. The run normally took ten days, but the vessel was struck by a ferocious squall that splintered the mast of its main topsail, delaying the ship several days. It was the first of many hindrances the surgeon would face on his American journey.
Lister stepped off the train from New York to Philadelphia on September 3. Although he was not a vain man, the forty-nine-year-old surgeon still adhered to the prevailing fashion of the day: he parted his wavy hair to the side and sported meticulously groomed muttonchops, now tinged with gray. Dressed conservatively in his fitted waistcoat and high starched collar, he adjusted his outer clothing and took in his surroundings. There was a tangible atmosphere of excitement, as the city was swelling with crowds who had come to visit the Philadelphia Centennial Exhibition.
Lister was met on the platform by hawkers selling small umbrellas designed to protect their users from both the harsh sun and the occasional thunderstorms that bedeviled the city at that time of year. These devices could be mounted atop a gentleman’s hat and adjusted by means of tapes attached to the shoulders. There were also handheld fans, refreshing “arctic” drinks, and cups of ice for sale. Boys dressed in cutaway jackets and floppy bow ties touted guidebooks for a nickel apiece to new arrivals who would soon wander around with mouths agape at the extraordinary spectacle of the exhibition set out before them.
It had been a hundred years since the Declaration of Independence had been signed in Philadelphia, and the city was bursting with patriotic pride in celebration of the centenary. The Centennial Exhibition was designed to mark America’s ascendancy as a leader in science and industry. In an era of large-scale fairs celebrating science and progress, the gathering in Philadelphia was even grander than London’s Great Exhibition of 1851, which Lister visited with his father. It featured thirty thousand displays from thirty-seven nations of the world, spread over an impressive 450 acres of land. Zigzagging through the fairgrounds were eighty miles of asphalt, bubbling and melting in the unrelenting heat. The world’s first monorail shuttled passengers the 150 yards between Horticultural Hall and Agricultural Hall. Sightseers gawped at an astonishing collection of exotic animals, including a fifteen-foot walrus, a polar bear, and a shark, all displayed alongside the weapons used to hunt them.
The focal point of the fair was Machinery Hall, where visitors could marvel at the engineering wonders of the age. Electric lights and elevators were powered by a 1,400-horsepower Corliss steam engine—the largest ever of its kind, weighing in at 650 tons. There were locomotives, fire trucks, printing presses, hulks of mining equipment, and magic lanterns. Recent innovations, such as the typewriter, a mechanical calculator, and Alexander Graham Bell’s telephone, were debuted to the appreciative public.
By September, the Exhibition was averaging an astonishing 100,000 visitors a day. But the British surgeon who had traveled over four thousand miles of ocean to America had only one aim in mind: to prove the merits of his antiseptic system. As Lister picked his way through the crowds, he braced himself for what might be awaiting him at the International Medical Congress.
Lister’s invitation to speak at the conference had come from one of his most vocal critics across the Atlantic. Samuel D. Gross was one of the country’s preeminent surgeons and was also a nonbeliever in the existence of germs. The American surgeon was so set against Lister’s antiseptic system that he had commissioned a painting a year earlier to celebrate his faith in the surgical status quo. In the Portrait of Samuel D. Gross (later known as The Gross Clinic), the artist Thomas Eakins depicts a dark and dingy operating theater. Gross, at the center of the scene, is operating on a boy who is suffering from osteomyelitis of the femur. The surgeon is surrounded by his assistants, one of whom probes the patient’s wound with bloodied fingers. In the foreground, unsterilized instruments and bandages are displayed within reach of equally unclean hands. There is no sign that Lister’s antiseptic methods are being used.
Some American surgeons had adopted Lister’s antiseptic system, though they very much remained in the minority. For instance, George Derby—who would later become professor of hygiene at Harvard University—read about Lister’s work shortly after it first appeared in The Lancet. Several weeks later, a nine-year-old boy who was suffering from a compound fracture of the middle thigh found himself in Derby’s care. Derby set the leg and then used carbolic acid to dress the wound. He reported, “At the end of four weeks, the [carbolic-acid-soaked dressing] was removed, disclosing a round, superficial ulcer, half an inch in diameter, which in a couple of days was covered with a firm scab. There is now … firm union of the bone.” Derby discussed his findings at a meeting of the Boston Society for Medical Improvement and published his observations in The Boston Medical and Surgical Journal on October 31 of that same year, crediting “Mr. Lyster [sic], a surgeon of Glasgow,” as his source of inspiration.
Similarly, at Massachusetts General Hospital, George Gay treated three patients suffering from compound fractures with carbolic acid. “The wounds,” explained Gay, “were treated essentially according to the method of Mr. Liston [sic].” The surgeon argued that the carbolic acid’s antiseptic qualities were possessed by no other compound that he had encountered in his research. Gay had full faith in Lister’s methods, as did two other surgeons at the hospital who used carbolic acid on at least five other patients during that period. Of course, a man changing the course of history is never without his detractors. The head surgeon, Henry Jacob Bigelow—a censorious and dogmatic man who was present at the historic operation with ether at Massachusetts General Hospital in 1846—banned Lister’s antiseptic system shortly after Gay and his colleagues began using carbolic acid, calling it “medical hocus-pocus.” He went as far as to threaten to fire those who ignored his orders.
With the paint barely dry on the depiction of traditional surgery that Samuel D. Gross had commissioned, Lister found himself in hostile territory. This was in spite of the fact that America had recently endured a civil war that claimed tens of thousands of lives due to the mismanagement of appalling battle injuries. For the duration of the war, American surgery remained crude, and wound infections spread unchecked. The bullet-riddled arms and legs of more than thirty thousand Union soldiers were amputated by battlefield surgeons, many of whom had little or no experience of treating trauma patients. Knives and saws were wiped free of gore with nothing more than dirty rags, if at all. Surgeons never washed their hands and were often covered in the blood and guts of previous patients at the commencement of a new operation. When linen and cotton were scarce, army surgeons used cold, damp earth to pack open wounds. When these wounds inevitably began to suppurate, they were praised for their laudable pus. Many surgeons had never even witnessed a major amputation or treated gunshot wounds when they joined their regiments, much to the detriment of those who fell under their care.
As horrific as the war was, doctors and surgeons gained a profound knowledge of clinical experience from treating seemingly numberless battlefield casualties, which in turn accelerated surgical specialization in American medicine. Most important, they acquired administrative skills that enabled them to organize ambulance corps and commission hospital trains. Soon after the war was over, veteran surgeons began to design, staff, and manage vast general hospitals. This made their profession more cohesive in its operational procedures and made it ripe for a new approach to the art of surgery when Lister arrived in the country.
* * *
At noon on September 4, Lister entered the University of Pennsylvania’s ornate chapel with other attendees of the International Medical Congress. On this first day, the antiseptic system came under immediate assault, with Lister sitting in the front row as speaker after speaker stood up to denounce all he believed in. One physician from New York noted th
at there was no satisfactory proof that germs were necessarily connected to illnesses such as cholera, diphtheria, erysipelas, or any other infectious disease. Another doctor, from Canada, cautioned, “Is it not to be feared that the particular treatment advised by Prof. Lister tends to divert the attention of the surgeon from other essential points?” The final blow came from Frank Hamilton, a battle-hardened Civil War hero, who reproached Lister directly. “A large portion of American surgeons seem not to have adopted your practice,” he said, looking down at the British surgeon from his podium; “whether from a lack of confidence or for other reasons, I cannot say.”
When the diatribes against him had at last ended, all eyes turned to this divisive figure. But Lister would have to wait till the second day of the conference to address his opponents. At the allotted hour on that day, he made his way to the front of the chapel, and he readied himself to defend a system he was certain could save tens of thousands dying in hospitals at that very moment. He flattered his audience: “American physicians are renowned throughout the world for their inventive genius, and boldness and skill in execution.” It was to their credit that anesthesia was now used in surgery. For two and a half hours, Lister lectured on the merits of antisepsis, concentrating on the interrelationship between dirt, germs, pus, and wounds. He peppered his talk with entertaining demonstrations and case histories. His conclusions were shrewdly simple: if germs were destroyed during an operation and prevented from accessing a wound afterward, no pus would form. “The germ theory of putrefaction is the foundation of the whole system of antisepsis,” Lister told his audience, “and, if this theory is a fact, it is a fact of facts that the antiseptic system means the exclusion of all putrefactive organisms.”
If Lister had nursed any hope that his diligence and reasoned argument concerning his antiseptic system would convert the American audience, he would be sorely disappointed. One attendee accused him of being mentally unhinged and having a “grasshopper in the head.” Others berated him for speaking so long. “The hour being late,” one critic whined, “I merely desire to point out a few facts which … militate against the [germ] theory, as far as it claims that a certain class of minute living organisms … are essential to disease-processes.” But it was Samuel Gross—the man who had hoped to discredit Lister by inviting him to speak at the International Medical Congress—who would have the final word: “Little, if any faith, is placed by any enlightened or experienced surgeon on this side of the Atlantic in the so-called treatment of Professor Lister.”
Lister would not be easily deterred from winning over American hearts and minds to his antiseptic system. After the conference, he set out on a transcontinental train journey that took him as far as San Francisco and back. He stopped in several cities along the way, lecturing to crowded rooms of medical students and surgeons about the value of antisepsis. Many of these men went on to test the efficacy of his system on their own patients and reported positive results.
In Chicago, Lister’s host was a former patient whom he had treated in Glasgow after she was injured in a mill. Although the woman had made a good recovery, she was no longer capable of manual labor after the accident. Concerned about her future, Lister intervened with the woman’s employer and asked that she be given a trial working in the department for design. She did so well at her new job that the firm sent her to America, where she was put in charge of the company’s exhibit at another fair held in Chicago, several years before the one Lister had attended in Philadelphia. While there, she met a young American manufacturer and married. When she heard of Lister’s visit, she was thrilled to welcome the man who had saved her life and open to him the doors of her home for the duration of his visit.
Toward the end of his trip, Lister performed an operation on Blackwell’s Island (now Roosevelt Island) in New York City. He had come at the request of William Van Buren, a distinguished surgeon who had heard Lister speak in Philadelphia. It turned out there were a few attendees who privately supported Lister. For instance, William W. Keen, a pioneer in neurological surgery, adopted antisepsis a month after the International Medical Congress. He later recounted, “For me it changed surgery from Purgatory to Paradise,” adding that he would never abandon Lister’s system. D. Hayes Agnew, also in attendance, adopted Lister’s techniques as well. Shortly afterward, he highlighted the subject in his book The Principles and Practice of Surgery. And then there was Van Buren, who was so impressed by Lister’s lecture that he invited him to perform a surgical demonstration for his students. On the appointed day, Lister watched in amazement as more than a hundred of Van Buren’s students filled the auditorium of Charity Hospital. “I had no idea that I was to address so large a body of students,” Lister said to the crowd. “It is a most unexpected privilege.”
Lister prepared to demonstrate his antiseptic techniques on a young man who had developed a large syphilitic abscess on his groin. He began by dipping his instruments and his hands in a basin full of carbolic acid as the patient was administered chloroform. While preparations were under way, one of the spectators opened a window to let in some air because the operating theater was packed to capacity. A hush fell over the room. Lister directed a volunteer to pump carbolic acid into the air directly over the operating table. As he was about to make an incision, a slight breeze blew the solution away from the patient. Turning to the window, Lister asked that it be shut and then used the episode to caution those in attendance that rigorous attention to all the details of the antisepsis routine was mandatory. He proceeded to operate, carefully slicing open the infected abscess, draining it of infective pus, and irrigating the wound with carbolic acid before wrapping the groin and upper thigh in antiseptic bandages. Lister’s lecture was recorded word for word by a student in the audience. When the demonstration was complete, the crowd cheered.
Before heading back to Britain, Lister moved on to Boston, and it would prove to be a serendipitous visit. There, he met Henry J. Bigelow, the man who had banned his antiseptic techniques at Massachusetts General Hospital. Bigelow hadn’t attended the medical conference in Philadelphia, but he had read reports about Lister’s lecture. Although he still wasn’t convinced about the existence of germs, he was impressed by Lister’s dedication to his system and the care and attention he paid his patients. Bigelow invited Lister to speak at Harvard University, where he was warmly received by the medical students in attendance. Not long afterward, the American surgeon delivered a lecture of his own. In it, he praised “the new doctrine” and confessed his conversion to Lister’s antiseptic system: “I have learned that the duty of the surgeon … should be to destroy the actual intruders [germs], and effectually to exclude their thronging companions.”
With Bigelow’s endorsement, Massachusetts General became the first hospital in America to make institutional use of carbolic acid as a surgical antiseptic. It was an extraordinary volte-face of policy in a hospital that for years had banned Lister’s methods and even threatened to fire those who dared implement them.
* * *
Lister returned to Britain, reenergized by the more positive reactions by Americans to his antiseptic system toward the end of his trip. Not long after he had settled back into Edinburgh life in February 1877, Lister received news that the renowned Sir William Fergusson had died. He had been professor of surgery at King’s College in London for thirty-seven years. After his death, the university approached Lister about the position. With the gradual acceptance of antisepsis at home and beyond Britain’s shores, Lister’s reputation was enviable. Students flocked to his classroom in record numbers. Prominent foreigners traveled thousands of miles to visit his wards and witness his operations. Although King’s College could have promoted Fergusson’s colleague John Wood, the members of the university’s council were inclined to prefer someone more distinguished to fill the vacancy. They could think of no one better suited to the role than Joseph Lister.
Unsurprisingly, Lister had concerns. He worried that he would not be given the same degree of freed
om in London that he had been granted in Edinburgh and responded to the unofficial offer from the university’s council members by laying out conditions of his own. He told them that if he were to take up the position at King’s College, his aim would be to introduce and diffuse his antiseptic system throughout the capital. He also hoped to institute a more efficient method of clinical teaching at the university, with an emphasis on practical demonstrations and experimentation.
Back in Edinburgh, Lister’s students were devastated when news about the negotiations and of his possible departure was leaked. At the end of one of his clinical lectures, they presented him with a formal plea signed by more than seven hundred students. Isaac Bayley Balfour, one of his pupils, read the document aloud: “We eagerly seize this occasion to acknowledge the deep debt of gratitude we owe the invaluable instruction we have derived from your clinical teaching.… [M]any have gone forth, and many will still go forth, determined to carry your principles into practice and spread … that system of surgery of which you are the founder.” The students applauded this sentiment. When the class had quieted down, Balfour continued. “The welfare of our school is so intimately bound up with your presence,” he told Lister, “we would yet earnestly hope that … the day may never come when your name will cease to be associated with that of the Edinburgh Medical School.” Lister was overwhelmed by his students’ response. To their delight, he told them that even if he should secure the topmost position in private practice in London, he could not take up a position at King’s College if it meant teaching clinical surgery in the way it was currently being taught throughout the capital.
The Butchering Art Page 21
