The chief of surgeons: our debt of gratitude to Joseph Lister By LEE RANDALL Published on Wednesday 1 February 2012 00:00 One of the finest minds of his generation, Joseph Lister spent 25 years working in Scotland and this year marks the 100th anniversary of his death SURGICAL intervention has become so commonplace - and so innovative - that it's hardly credible that less than 150 years ago it was a crude last resort, fraught with stress for both doctors and patients. Especially prior to the first use of anaesthesia in the UK, in 1846, surgery primarily consisted of amputations, done at speed. Doctors preferred treating patients conservatively, but many died of sepsis infection anyway. When they did operate, even if surgery was successful, a majority of their patients still succumbed to infection. That's why everyone who has gone under the knife owes a debt of gratitude to Joseph Lister, the pioneer of aseptic surgery, and that's the reason to celebrate the centenary of his death this year. In an age when germs were barely understood, Lister's research into treating wounds and surgical instruments with carbolic acid (phenol) transformed surgical practice. Procedures became safer and post-operative life expectancy soared. Soon doctors were able to perform a wider range of life-saving emergency operations and undertake planned elective surgery, as well. Surgeon's Hall museum in Edinburgh is mounting an exhibition devoted to Lister, while Edinburgh University, along with corporate sponsors Johnson & Johnson, is holding a two-day scientific conference (complete with a surgical competition for students). And there will be a free public lecture by Professor James Garden, the 12th Regius Professor of clinical surgery at the University of Edinburgh - the doctor who undertook the first successful liver transplantation in Edinburgh, in 1992. "You can divide surgery into pre-Lister and post-Lister," says Garden, and the Victorian Royal Infirmary he describes sounds absolutely terrifying. The old building on Infirmary Street, when it was built, had no running water; it had to be carried in in pails. It was not uncommon to have patients sharing a bed. Everything was a bit dirty. They heated the infirmary with coal fires. Lack of light and a bad atmosphere were all accepted practice. And the nurses, God bless them, were often rather disreputable and might actually be drunk while in charge of the patients. Lister, originally from Essex, had already earned a Bachelor of Arts degree and qualified as a doctor in 1850, at University College, London. He became a Fellow of the Royal College of Surgeons (FRCS) in 1852. He came to Edinburgh in 1853 to spend a few weeks studying under James Syme, a surgeon renowned for being innovative and fast. Lister was so impressed by Edinburgh's medical community, and Syme himself, that he abandoned plans to continue travelling and wound up spending the next 24 years in Scotland. Lister was one of seven children in a prosperous Quaker family, and his was an interesting background, says Garden. His father did not have a degree, but there was a family tradition of making wine and they were quite wealthy. His father was an entrepreneur and designed his own microscope, and ultimately became a Fellow of the Royal Society in London. For someone who had no previous degree, it was a remarkable achievement. Lister was very close to his father, and wrote to him often. So while Lister was being brought up, he was already into experimentation. He was precocious, finishing his first degree by the time he was 18 or 19. He decided at an early age to be a surgeon. It's thought that this is because he did a lot of animal dissections and liked looking down the microscope at whatever he was working on. This gave him a tremendous advantage, because he was already a scientist, in a way. He was also fluent in German and French, giving him access to cutting-edge research being published on the continent. Some of Lister's early work included studying the muscular control of the iris and, via animal research, exploring blood flow and the effects of inflammation. Later in his career he was one of the few surgeons repairing fractures with metal wire, but his second great contribution to surgery was the development of ligatures (or ties) made of catgut. Garden says: "When you were amputating, you tied off the blood vessels, and traditionally they were made of silk or linen. Because they weren't sterile, they would be a source of infection. Lister worked out that one of the materials you could use safely was catgut, but it degraded quite quickly. He worked with industry to develop ties that would last longer, developing a technique of treating the catgut with chromic acid. "When he gave lectures in the United States, a chemist in attendance went back and spoke to his bosses and said, "I think we should develop this." That became the basis of a company known as Johnson & Johnson. Their existence is all down to a lecture that Lister gave. Lister was popular, known for being direct, honest, unostentatious and without affectation. Syme was called The Master by his students and colleagues, and Lister was quickly dubbed The Chief. "His colleagues recognized Lister as a bit of a leader, a bit of an innovator, and a bit of a task master, as well, I suspect," says Garden. But growing up in a large family, you have to get on with people, and he clearly did. Marriage to his mentor's daughter was a source of personal and professional strength. Perhaps because she was a surgeon's daughter, Agnes was instrumental in recording Lister's work. "It was a quickish romance," says Garden. Within a year of his arrival in Edinburgh they married in Symes's home. There were no children. When you read behind Lister's lectures, it's evident that he was not always best prepared. He would work until the small hours pulling together his talks, with his wife helping him. And it seems to be a fairly regular occurrence that at the last minute he was still changing notes as he went off in a horse and carriage to deliver the lecture. So she was obviously very supportive. Chris Henry, director of heritage at Surgeon's Hall, says one of Agnes's diaries is coming up on loan from the Wellcome Trust. There is a very strong link showing that she prepared a lot of the notes. And we have a letter from him from Italy, when she died in 1893, referring to not really knowing what to do with himself afterwards. Effectively, from that moment on, he became more of a recluse. In 1860 Lister was appointed to the Regius chair at Glasgow University, but it was another eight months before he did his first operation at the Glasgow Royal Infirmary - even the chair had to apply for operating rights, and Lister's innovative theories criticising common practice rubbed people up the wrong way. Overall, Lister was unhappy in Glasgow, despite making some of his most important scientific breakthroughs there, building on work being done by Louis Pasteur, in France. "He tried to leave Glasgow twice," admits Garden. His time in Glasgow is marked by repeated episodes of disagreement, and when he left, he couldn't resist writing a long letter indicating that it was really remarkable that he'd achieved anything, because the management hadn't supported him, the conditions they'd provided were very poor, and even the new Western Infirmary they'd built wasn't as good as it could have been. So he established his international reputation before his national reputation. He promoted the idea of antiseptic surgery, but nobody was prepared to believe it, not the surgeons in Glasgow, not in Edinburgh, not in London. He had to work very hard to provide evidence that his techniques were correct. The seminal case is that of James Greenlees, an 11-year-old boy who had been run over by an empty cart in the street, and had a compound fracture of his left leg. This was 12 August, 1865. It was the first successful report of healing without infection and without amputation. The cases he reported that established his reputation amounted to 11, and the last of these was in April 1867 - so it took almost two years to accumulate 11 cases. After Syme suffered a stroke, in 1869, Lister finally found a way to return to Edinburgh to take up his father-in-law's spot as the Regius chair of Surgery, encouraged by a petition signed by 150 medical students who begged him to leave Glasgow. Years later, when a fresh - and accurate - rumour arose that he was leaving for London, a new petition garnered more than 700 signatures from those desperate for him to remain in Scotland. So while some of Lister's colleagues found his ideas antagonizing, to students he was a hero. Lister became the royal surgeon, and was even present when Queen Victoria had an armpit boil lanced, to ensure that the wound didn't get infected. He was granted the freedom of Glasgow, Edinburgh and London, made a lord, and given a baronetcy. He was one of the original members of the Order of Merit, and is the only Fellow of the College of Surgeons in Edinburgh to be additionally elevated to Honorary Fellow, in 1905, to mark their 400th anniversary. Having felt the scalpel's bite, I know I owe him my life - and suspect many of you reading do, too. To book tickets for Professor Garden's lecture on Saturday 11 February, at 1:30pm, visit: www.ed.ac.uk. The lecture, which is free, but ticketed, will be held in the anatomy lecture theatre (doorway 3, 1st floor), Medical School, Teviot Place, EH8 9AG. The exhibition at Surgeon's Hall museum runs from 13 February to 20 September, and is included in the £5 admission fee for the museum.