Part 16 (2/2)

About the same time certain other reforhtingale, were tried in various places, tending to reater cleanliness; but till the cause of theresults could be obtained, and no real victory could be won Hence a radical policy like Sieons subarded as inevitable, it was an advantage to have any one boldly advocating a big h and outside to carrywith him But before 1869 another line of attack had been initiated fro principles which were to win the battle with oas no reat towns; in fact it suffered more than most of them With its rapid industrial development it had already in 1860 a population of 390,000 Its streets were narrow, its houses often insanitary In the haste to make money its citizens had little time to think of air and open spaces The science of town-planning was unborn Its hospital, far froe of position, was exposed to peculiar dangers It lay on the edge of the old cathedral graveyard, where the victims of cholera had received promiscuous pit-burial only ten years before The uppermost tier of a multitude of coffins reached to within a few inches of the surface These horrors have long been swept away; but, when Lister took charge of his wards in the Infirenerated so close at hand, and in consequence they presented a gruesome appearance The patients came from streets which often were foul with dirt, sloorene were firmly established

In such an environh his heart must have sunk within hirim adversaries For two years, indeed, he was chiefly occupied with routine work and practical improvements; but he continued his speculations, and in 1861 an article on aery_, a large work in four volumes published in London, showed that he had not lost his power of surveying questions broadly and exaht He was not in danger of letting his mind be swamped with details, but could put them in their place and subordinate them to principles; and his article is chiefly directed to a philosophical survey which would enable his readers to go through the same process of education which he had followed out for hiow disciples, once illustrated this philosophic spirit fro the many scientists who 'render the that it is strange or needs explanation) with the feho 'render thee to the familiar'--who stand away from the phenomena to which every one has become too accustonized the peculiar gift which enabled him to rise superior to his subject, and to interpret as to his colleagues a sealed book In these days, aes of the hospital, his as perpetually putting questions to hiht come at any moment and from any quarter

As a fact, already, far fro while out of his ken, there orking in France the most remarkable scientist of the century, Louis Pasteur, who more than once put his scientific ability at the disposal of a stricken industry, and in his quiet laboratory revived the industrial life of a tee population Abeetroot-alcohol and was threatened with financial ruin, appealed for his help in 1856; and Pasteur spent years on the study of fer countless experiments to test the action of the air in the processes of putrefaction, and coen of the air was not responsible for them, as idely believed He went further and reached a positive result He satisfied hianisms carried in the dust of the air, and that the process was due tofaerms' or 'microbes' The existence of these infinitesimal creatures was known already to scientists, but their irasped till Pasteur, in the years 1862 to 1864, expounded the results of his long course of studies He himself was no expert in medicine, but his discovery was to bear wonderful fruit when it was properly applied to the science of health and disease Lister's study of open wounds, his observation of the harm done to the tissues in them when vitality was impaired, and of the value of protective scabs when they formed, enabled him to see the way and to point it out to others When in 1865 he first read the papers which Pasteur had been publishi+ng, he found the principle for which he had so long been searching With what excitement he read thee, we do not know; he has left no record of his feelings at the time: but it was the most important moment in his career, and the rest of his life was spent in applying these principles to his professional work

With his e of the true source of thethat he had to assist in a battle between the deadly ger to defend themselves, Lister returned afresh to the study of erererms on the dust in the air He er an irritating effect on the tissues and weakening their vitality The relative importance of these various factors in the problem only time and experience could tell him Carbolic acid had been discovered in 1834 and had already been tried by surgeons with varying results At Carlisle it had been used by the town authorities to cope with the foul odour of sewage, and Lister visited the town to study its operation In its cruder form carbolic proved only too liable to irritate a wound and was difficult to dissolve in water Lister tried solutions of different strengths, and finally arrived at a form of carbolic acid which proved to be soluble in oil and to have the 'antiseptic' force which he desired--that is, to check the process of sepsis or putrefaction inside the wound He also set himself to devise so ithout further interference from without Animals have the power to form quickly a natural scab over a wound, which is impermeable and at the saht wound, in a pure atmosphere, may heal quickly; but a serious wound'pus' at intervals, while deco the vitality of the patient Lister made numerous experiments with layers of chalk and carbolic oil, with a co of which he could think, to imitate the work of nature His inexhaustible patience stood hiht speak contemptuously of the 'carbolic treatment' and the 'putty method' as if he were the vender of a new quack medicine; but at the back of these details was a scientific principle, fir in the dark

[Illustration: LORD LISTER

Fro 1866 and 1867 we see from his letters how he set himself to apply the new principle first to cases of compound fracture and then to abscesses, how closely and anxiously he watched the progress of his patients, and hoas to claim a victory before his confidence was assured In July 1867, when he was just forty years old, he felt it to be his duty to communicate what he had learnt and to put his experience at the disposal of his felloorkers He wrote then to _The Lancet_ describing in detail eleven cases of compound fracture under his care, in which one patient had died, one had lost a limb, and the other nine had been successfully cured This ratio of success to failure was far in advance of the average practice of the ti that he met with the common fate which rewards pioneers in new fields of study It is true that other refor to reduce the nuale had led the way, and eood results had been achieved by other methods, and that Lister's proofs were in no way decisive But there was no need for critics to misapprehend the nature of his claiiarism Sir James Simpson revived the memory of a Frenchman, Lemaire, who had used carbolic acid and written about it in 1860, and refused to give Lister any credit for his discoveries As a fact Lister had never heard of Lemaire or his work; and, besides, the Frenchman had never known the principles on which Lister based his work, nor did he succeed in converting others to his practice How little the personal question need be raised between hest character is shown by the relations of Darwin and Wallace, who arrived independently and alin of species, Wallace put his notes, the fruit of many years of work, at the disposal of Darwin; and both continued to labour at the establishnition to the other's part in the work

Unmoved then by this and other attacks, Lister continued his experireatest pains, for years in succession, in i to narrate his struggles with carbolized silk and catgut in the search for the perfect ligature, which should be absorbed by the living tissues without setting up putrefaction in the wound; or his countless experi which should be antiseptic without bringing any irritating substance near the vital spot These latter finally resulted in the choice of the cyanide gauze, which with its delicate shade of heliotrope is now a faery But one story is of special interest because it shows us clearly how Lister, while clinging to a principle, was ready to modify the details of treatht him It was on the advice of others that he first introduced a carbolic spray in order to purify the air in the neighbourhood of an operation At first he used a small spray worked by hand, but this was, for practical reasons, changed into a foot-spray and afterwards into one worked by steaine was a cumbrous bit of apparatus to carry about with him to operations; and Lister all his life loved simplicity in hison the hands of the operator,his instruments Lister hieons; with sorave handicap The spectators at a demonstration found it inconvenient, and in one instance at least we know that the patient was upset by the carbolic vapour reaching her eyes This was no less a person than Queen Victoria, upon whom Lister was called to operate at Balmoral in 1870 About the use of this apparatus, which was an easy mark for ridicule, Lister had doubts for some tirowing conviction that it did not afford the security which was clai in 1881; in 1887 he abandoned the use of the spray entirely; in 1890 he expressed publicly at Berlin his regret for having advocated what had proved to be a needless co operations In adopting it he had for once been ready to listen to the advice of others without his usual precaution of first-hand experi it he showed his conteness to adow that Lister made his initial discoveries and conducted his first operations under the new systeow Infirmary that he worked cures which roused the astonisheneration ht be He had formed a school and was happy in the loyal service and in the enthusiasm of those orked under him, and he had no desire to leave such a fruitful field of work But when in 1869 his father-in-laing to ill-health, resigned his professorshi+p, and a nuh students addressed an appeal to Lister to becoly draards the city where he had married and spent such happy years No doubt too he and his ished to be near Syme, who lived for fourteendays Lister was elected in August 1869 and h two months later For a while he took a furnished house, but early in 1870 he made his hoardens between Princes Street and the Castle, 'a grand place'

for his daily meditations, as he had it all to hih was a pleasant change to hi; and the one man as likely to stir controversy, Sir Ja his fellow professors were ures being old Sir Robert Christison of the ist, and Blackie the classical scholar The hospital was still run on old-fashi+oned lines; but the staff were devoted to their work, froreat 'character' whose portrait has been sketched in verse by Henley,[47] to the youngest student; and they were ready to co-operate heartily with the new chief The hours of work suited Lister better than those at Glasgohere he had begun with an earlyvisit to the Infirmary and had to find time for a daily lecture Here he limited himself to two lectures a week, visited the hospital at e aical study, which was his chief interest at this time

[Note 47: W E Henley, poet and critic, 1849-1903 His poems, 'In Hospital' include also a very beautiful sonnet on 'The Chief'--Lister himself, which almost calls up his portrait to one who has once seen it: 'His brow spreads large and placid Soft lines of tranquil thought His face at once benign and proud and shy His wise rare sht years, and it was during his tiical questions quickened by the Franco-German war, and had to realize how incomplete as yet was his victory over the forces of destruction So British and American doctors, who volunteered for field-service, came to him for advice, and he wrote a series of short instructions for their guidance; but he soon learnt how difficult it was to carry out his methods in the field, where appliances were inadequate and where wounds often got a long start before treatment could be applied The French statistics, co to read: 90 out of 100 amputations proved fatal, and the total number of deaths in hospital worked out at over 10,000 The Germans were in advance of the French in the cleanliness of theirto accept the antiseptic theory; but it was not till 1872 that this principle can be said to have won the day The hospitals on both sides were left with a ghastly heritage of pyae almost unchecked in their wards; but, in the two years after the war, two of the most famous professors in German Universities[48] had by antiseptictheir patients that the superiority of the treatave full credit to Lister as their teacher When heup with visits to the chief reeting hi Sir Rick on the indifference of his country was by theland, refurbished froh, to carry the torch of learning to the south

[Note 48: Professor Volkmann of Halle and Professor von Nussbauues, with all their opportunities for learning at first hand, seeely indifferent to Lister's presence in their es to the central shrine of antiseptics The real encourageed his lecture-room to the number of three or four hundred, with sustained enthusiasm In some ways it is difficult to account for the popularity of his lectures He made no elaborate preparations, but was content to devote a quiet half-hour to thinking out the subject in his ar his ideas and the developrasp that he could follow it out clearly and could hold the attention of his audience His voice, though reat power He was often iht stammer, especially at the end of a session He was not naturally an eloquent hts of rhetoric But it seems impossible to deny the possession of special ability to a hout a long career; and if it was the matter rather than the ood speaking which Scotslishreater effort than at Glasgow for Lister to strike his tent and adventure hiround It is true that London was his early hoive hier income by private practice; yet it is very doubtful whether these ain, now that he had reached the age of fifty But he was a man with a mission Some of his few converts in London held that only his presence there could shake the prevailing apathy, and he himself felt that he must make the effort in the interests of science

The professorial chair to which he was invited in 1877 was at King's College, which was relatively a sh standard; the classes which attended his lectures were s to an unfortunate incident he was handicapped at the start When receiving a parting address froh students he made an informal speech in the course of which he co at Edinburgh and London, in ter to the southern metropolis

Some comparison was natural in the circu for publication and had no idea that a reporter was present

But his reht be expected The sting of the criticiseons were only too ready to resent anything whichso the ill feeling which resulted; but at first, even in his own hospital, he was met by coldness and opposition in his attempt to introduce new methods In fact, had he not laid down definite conditions in accepting the post, he could never havewith him some of the men whoh surgeons, the foremost of ere John Stewart, a Canadian, and Watson Cheyne, the faeneration Even so he found his orders set at naught and his work hampered by a temper which he had never known elsewhere In some cases the sisters entrenched themselves behind the Secretary's rules and refused to comply, not only with the requests of the new staff, but even with the dictates of common sense and humanity

Another trouble arose over the system of London examinations which tempted the students to reproduce faithfully the views of others and discouragedti was designed to foster the spirit of inquiry, and he would not deign to fill his lecture-roo'

Never did his patience, his hopefulness, and his interest in the cause have to subreater trials; but the day of victory was at hand

The ress held at Areat European nations One sitting was devoted to the antiseptic syste an address, received an ovation so marked that none of his fellow-countrymen could fail to see the esteem in which he was held abroad Even in London uished of theet, openly expressed remorse for his reluctance to accept the antiseptic principle earlier, and compared his own record of failures with the successes attained by his colleague at St Bartholoiven Listerish trial Other triumphs followed, such as the visits in 1889 to Oxford and Carees, the offer of a baronetcy in 1883, and the conferring on him in 1885 of the Prussian 'Ordre pour le merite'[49]

But a chronicle of such external matters is wearisome in itself; and before the clie turn of fortune, already setting in another direction

[Note 49: Restricted to thirty Gern members]

This was due to the introduction of the so-called aseptic theory so widely prevalent to-day, of which the chief prophet in 1885 was Professor von Bergmann of Berlin Into the relative ree, it is absurd for laymen to enter; nor is it necessary to make such comparisons in order to appreciate the exaained by the abandonment of carbolic and other antiseptics which ency of heat for killing all germs But Lister himself took enormous pains to keep his antiseptic as remote as possible from the tissues to whose vitality he trusted, and went half-way to meet the aseptic doctrine If he retained a belief in the need for carbolic and distrusted the elaborate ritual of theconnected with an operation, it was not either from blindness or fro the spray, it was his love of simplicity which influenced him If the detailed precautions of the complete aseptic system are found practicable and beneficial in a hospital, they are difficult to realize for a country surgeon who has to work in a humbler way, and Lister wished his procedure to be within reach of every practitioner who needed it

OneListerism to be superseded In time of war there are occasions when necessity dictates the treatment to be followed Wounded men, picked up on the field of battle some hours after they were hit, are not fit subjects for a method that needs a clear field of operation It is then too late for aseptic precautions, as the woundwith bacteria Only the proes of putrefaction; and Lister's ed,the late War

In any case there is round between the two schools: each can learn from the other, and those professors of asepticised their debt to Lister have been wiser than those who have made contention their aim This was never the spirit in which he approached scientific problems

An earlier controversy, in which his naed round the practice of vivisection Here Lister had practically the whole of his profession behind him when he boldly supported the claims of science to have benefited humanity by the experiments conducted on ani to the latter

And it ell that science had a chaentleness and moderation was so well established Queen Victoria herself showed a lively interest in this fiercely-debated question; and in 1871, when Lister was appealed to by Sir Henry Ponsonby, her private secretary, to satisfy her doubts on the subject, he wrote an admirable reply, calm in tone and lucid in stateht against his profession