Thursday, January 18, 2007

10 February: Boreham on Lord Lister

A Golden Tradition
In view of the sensational strides that surgery has taken in recent years, it is eminently fitting that we should offer our homage to the illustrious memory of Lord Lister, the anniversary of whose death we mark today. It is scarcely an exaggeration to say that the history of surgery divides itself into two epochs—before Lister, and after. In the old days, as Tyndall put it, "we were scourged by invisible thongs, attacked by impenetrable ambuscades, and it was only under the leadership of Lister that the light of science was thrown upon the murderous dominion of our foes." The brave story represents one of our classical romances.

With no traditions to suggest such a destiny or move him in that direction, Lister resolved, when quite a child, to be a surgeon. None of his relatives were attached to the medical profession, and it is doubtful if the boy had ever spoken to a doctor in his life. He was adamant, however, and never for a moment swerved from his early purpose. As soon as he entered his 'teens he began to macerate the bones and articulate the skeleton of every creature he could lay his hands upon. His parents, Quakers of the old school, viewed his grim propensities with feelings akin to horror. His father was proud of the boy's penchant for scientific research, but he shook his head gravely at the ideas of his son becoming a surgeon.

Surgery The Handmaid Of Nature
For what, after all, does the antiseptic doctrine amount to? If we forsake for the nonce the technical and academic terminology of the schools, and reduce the matter to the common parlance of the street and the fireside, it simply means that Pasteur in France and Lister in England aroused the medical fraternity to a recognition of the fact that, favourable conditions having been secured, Nature itself is the supreme healer. It is not the business of the surgeon to heal, but to obtain for Nature those conditions for which it imperatively stipulates. Any surgeon will confess that it is not in his power to heal a wound. The wound must heal itself. His duty consists in keeping it so immune from foreign substances, and so free from malignant bacteria, that the injured limb gets a fair chance of compassing its own restoration. Some vague hints of all this had been detected, and their significance suspected, away back in mediaeval times. But it was reserved for Lister to read the secret rightly and to transform our schools of surgery by giving it practical demonstration and effect. The work was slow, but he never lost heart and never looked back, and, in a way of which he never even dared to dream, he came into his own at the end.

Within the memory of men still living, Lister stood, with his back to the wall, fighting as a man fight for his life on behalf of that new conception of surgery with which his name will always be associated. He fought, not as a pugilist, but as a knight. There was a winsomeness and a chivalry about his engaging personality that completely disarmed his critics and opponents. He was absolutely sure of his ground, and he exhibited his confidence, not in noisy bluster, but in quiet strength. W. E. Henley, the poet and the friend of Robert Louis Stevenson, was once operated upon by Lister. Acknowledging his indebtedness to the distinguished surgeon who had thus saved his life, Henley said that "his rare, wise smile was sweet with certainties." The exquisite phrase reflects, as eloquently as mere words can do it, the calm and gracious poise of Lister's mind.

Laurels That Were Late, But Luxurious
At the time of Lister's advent, the situation was desperate. Doctors stood appalled at their own helplessness. The stars in their courses seemed to be fighting against them. Disease was spread by the very people who were seeking most assiduously to cure it. Surgeons carried contagion from patient to patient; nurses bore it from bed to bed on their aprons, bandages, and sponges. To sentence a patient to an operation was like signing his death warrant. Lister was worried to the point of distraction. He resolved to probe the problem to its very heart. As a result, he came to a sensational conclusion. The whole trouble, he announced, was—dirt! So, to the elimination of dirt, in every shape and form, he applied his stately powers. His new crusade awoke a storm of opposition. At the meetings of the British Association held at Leeds in 1869, Lister was roundly charged with arrant stupidity. Four years later, the "Lancet" warned the entire profession against him. At Edinburgh, Professor Caird, then a student, was solemnly adjured to have nothing whatever to do with him. The fierce campaign lasted until 1877, Lister being then 50. In that year the tide turned.

Lister was made Professor of Clinical Surgery at King's College Hospital. Almost immediately, his former enemies rallied to his side. Sir James Paget recanted and frankly withdrew earlier strictures. "I look back with shame," Sir James declared, "on that part of my life." In 1883, Lister was made a baronet, and, in 1897 was raised to the peerage. It was the first occasion on which a member of the medical fraternity had been so honoured. At the Coronation of King Edward the Seventh, Lister was made a Privy Councillor. "What pleased me far more than the honour," he said, "was the fact that the King shook hands with me, and said that, but for me, he could not have lived to wear the crown." Lister died in 1912. A grave in Westminster Abbey was offered, and declined, but a noble monument perpetuates his memory there. Men of such a mould are the glory, not only of a nation, but of all mankind; and it is fitting that, on every suitable occasion, we should recall their heroic achievements and acknowledge the incalculable debt under which they have placed us.

F W Boreham

Image: Lord Lister

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