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Lord Joseph Lister

DON'T break a leg... especially in the Victorian Era. Aarati tells the story of the surgeon who revolutionized medical care with his antiseptic method. 

Episode Transcript Aarati: 0:10 Hi, Arpita. Arpita: 0:11 Hi, Aarati. How are you? Aarati: 0:13 Um, pretty good. How are you? How's your January been going? Arpita: 0:17 Honestly, not too bad. Um, I'm kind of just, getting back into the swing of things. Um, you're looking very cute with your hair today. Aarati: 0:26 Thank you. Thank you so much. Arpita: 0:28 Did you get a little haircut? Aarati: 0:29 Yes, I did get a haircut. I went to the salon. It was so overdue. I think the last time I had gone was in July. Arpita: 0:37 Oh my gosh! Aarati: 0:38 Yeah, I really, I really like wait until I look absolutely horrid and then I go to him and I'm like I'm so sorry my hair is a mess I need you he works his magic and then I disappear on him for like six months again. Arpita: 0:51 Yep every time I go they're like you should really be coming every two to three months and I'm like oh my god for sure I will definitely come back and then never do. Aarati: 1:00 Yeah and that's literally what I said to him he's like oh so when will I see you again I'm like I'm gonna try really hard to make it no longer than four months, I feel like once I get back from the salon, I'm like, my hair is so fresh, and it's so cute, and I love it... Arpita: 1:15 and then you feel so pretty, and then you're just like, why don't I do this all the time? Aarati: 1:19 Exactly, I really should maintain this, I really should, like, do a better job, and then I just never do, so... Arpita: 1:27 I feel that yeah, but how are things with you, otherwise? Aarati: 1:30 Yeah, things are going really well. Um, I had a really good time researching this story for today and it's kind of a long one so i'm just wondering if we should just jump right in because I tried to shorten it like I really really did and I just I was just like everything there's so much information about him That I was just like, okay, I can't I can't so maybe... Arpita: 1:55 sounds like a really a really juicy story. Yeah Okay, let's let's dive right in. Who are we talking about today? Aarati: 2:00 Okay. So today we are talking about Joseph Lister. He is the father of modern surgery and antiseptic practice. So have you heard of him? Arpita: 2:12 Is that Listerine? Aarati: 2:14 It is Listerine, yes. Arpita: 2:16 Oh, nice. Aarati: 2:18 Yeah, I was gonna ask you that at the end if you could guess, like a household item, you know. Yes, it is Listerine, although he did not invent Listerine, but the person who invented it named it after him, so. Arpita: 2:31 Oh, okay, great. Aarati: 2:33 Yeah, so. Like I said, there is just so much information on this guy because we have the letters that he wrote to his father every week. So we practically know what he was thinking every single week of his life. Arpita: 2:47 Wow. Aarati: 2:47 And we also have all of his notes, like all of his scientific notes. And then his own nephew wrote his biography. So we have like, in the family... Arpita: 2:56 So detailed. Aarati: 2:56 Yeah, there's so much information, and I also at the top of the episode wanted to add in a trigger warning for our listeners because we will be talking about surgery and medical procedures like amputations and it's It's, it's really honestly not too bad. I tried to keep the blood and gore levels down, but just consider this your kind of fair warning. Arpita: 3:18 That might be a trigger warning for me, honestly. I am so squeamish when it comes to blood and I have such a low bar with like movies and TV shows. I just like a faintest bit of blood and my eyes are shut. So that might actually be directed towards me Aarati: 3:35 Okay. Oh, I'm sorry. I have the opposite. Like, I'm not squeamish really at all. And so I'm going to try really hard Arpita: 3:41 Yeah, we'll meet somewhere in the middle. Aarati: 3:43 Yeah, exactly. Um, okay. With that, let's get into it. So Joseph Lister was born to a wealthy Quaker family in April 1827 in a village called Upton near London, England. He was the fourth child of seven siblings. His mother, Isabella, was a school assistant, and his father was named Joseph Jackson Lister, or JJ Lister. So we're gonna call him JJ because they're both named Joseph Lister. His father, JJ, was an avid microscopist. So, back then microscopes weren't really actually considered a scientific tool at all. It was more of a toy that like rich people had and they could show their friends cool stuff on slides. Um, but scientists really didn't trust what they saw under microscopes as actual scientific evidence because there was so much light refraction and like weird colored halos that would form because the lenses were so bad. So, J. J. spent his life studying optics and improving microscope lenses, and his work was considered so influential that it elevated histology, which is the study of microscopic structures, to its own field of science. And he was elected into the Royal Society so Arpita: 5:03 That is... Aarati: 5:04 That's his dad. Like, yeah, that's... Arpita: 5:07 Okay. So we're already starting with like a bang here. Aarati: 5:10 Yeah. So little Joseph then grew up very close to his father and he grew up in this very scientific atmosphere and as a child he would go out and he loved to collect and dissect small animals, fish, and plants and look at them under his dad's microscope and he would draw what he saw using this device called a camera lucida, which basically was this optical device that would project what you saw under the microscope onto a piece of paper so you could trace it. Arpita: 5:40 Oh, that's cool. Kind of like a light box a little bit. Aarati: 5:43 Yeah, I think so. That's what I was envisioning. Arpita: 5:45 Another science illustrator. Aarati: 5:47 I know, right? Arpita: 5:48 I like that we have all these scientific illustrators and scientific artists. Aarati: 5:54 Yeah, so he would draw. What he saw, and probably because of this, I'm gonna say, from a very young age, Joseph made up his mind that he wanted to be a surgeon. And to me, that totally made sense. I'm like, yeah, you like dissecting animals and fish and looking at the structures, you want to be a surgeon, it makes sense. But this actually came as a bit of a surprise for his family. First of all, because no one in his family was in the medical field. But also because you kinda need to understand what surgery was like in the Victorian era. Arpita: 6:28 Uh huh, uh huh, uh huh, yes. It was like the barbershop surgeon situation, right? Aarati: 6:32 Yes. Arpita: 6:33 Like, Sweeney Todd? Aarati: 6:34 Yes, very much like So bloody, yeah. So In those times, undergoing an operation was super dangerous, it was very, very painful, and it was always your last resort. This was pre anesthesia, so patients were not knocked out, they were wide awake while the surgery was happening. So, a lot of screaming, a lot of pain, they often had to be held down while the surgeons operated on them. Surgeons were basically like butchers, and they were usually covered in blood and gore from their operations. And also, unlike today, surgeries were often public spectacles, they would happen in these large theaters where anyone from off the streets could come and watch and drag in their dirt into the operating arena, so they would come and just to see, like, the patient is screaming, are they gonna live or die? It's like high entertainment. Arpita: 7:36 Oh my god. Aarati: 7:38 Yeah, so. Arpita: 7:41 I'm not even, I'm not even phased by them bringing in the dirt. I'm just, that's something that you want to watch. Period. End of sentence. That's something that you, what should I do on my Saturday afternoon? I'm actually maybe might watch someone die. That sounds fun. Aarati: 7:57 Like, oh, is this, is the surgeon going to be able to pull this off? Or is the patient going to die before it happens? So. Arpita: 8:04 That's wild. Aarati: 8:05 Yeah. Arpita: 8:06 Wild and gross, but wild. Aarati: 8:08 That's all the level of detail I'm going to go into. But if you aren't squeamish and you would like to read more, a lot of the research from this story, I got from this fantastic book called The Butchering Art by Lindsay Fitzharris, um, she's done a seriously deep dive on Lister and also like the whole landscape of Victorian era surgery, what it was like before and after Lister entered the field. So, highly recommend that book if you would like to read more about Lister, but. Arpita: 8:45 Yeah, and maybe we'll link it in the show notes. Aarati: 8:48 Oh yes, I'll definitely it on the website along with all the other sources that I used for the story today. So. As a surgeon, then, because of all of these things, the faster you perform the operation, the better of a surgeon you were, because A, it decreased the amount of time that the patient was screaming in agony, and B, there was less of a chance that the patient would bleed out and die from the surgery, so There's not a lot of time for finesse, the faster you are, the better of a surgeon you are, and It doesn't matter if a little bit of extra gets taken off along the way, you know? Arpita: 9:23 Okay, so they're not anesthetized. Aarati: 9:26 Correct. Arpita: 9:26 But they, I assume also, there's no one's getting a transfusion, if they lose blood or whatever, you're just, you're just losing the blood. Like no, No fluids are being replaced the way you would think about in modern surgery. Aarati: 9:40 Yeah, not at all. Arpita: 9:41 What happened after? Did they like, close wounds? Was there suturing? Or is there... Aarati: 9:46 yeah, so it's like, after you, after you cut off whatever needed to be cut off, they would quickly tie off any arteries that were, you know, um, spurting blood, basically, and Arpita: 9:56 Christ. Aarati: 9:57 Hope that the patient lived. Yeah. They would just bandage it up and be like, okay, hopefully that worked. We'll see. Arpita: 10:04 I feel like I've heard, and I don't know if this is true, that they would just give, alcohol to patients to make them just, like, a little drunk, a little tipsy, so they wouldn't feel it as much? Is that real? Aarati: 10:14 I don't know. I didn't read about that. I wouldn't, uh, be surprised if some patients voluntarily did that, you know, because the patients, like I said, are wide awake, they're going into this arena, and they're seeing all these, like, bone saws and things that they know are about to chop off their leg or whatever it is, and Arpita: 10:33 Yeah. Aarati: 10:34 Yeah, no one could begrudge them a stiff drink before that, so. Arpita: 10:37 Or after, or during, or anywhere in between. Aarati: 10:40 Exactly. So back then, if you wanted to be a surgeon, which again, like, now I understand why it was very surprising to Lister's family that he wanted to be a surgeon, that he wanted to enter this profession. If you wanted to be a surgeon, you didn't need to go to medical school at all. Normally you would get an apprenticeship at an apothecary, which is basically like an old time pharmacy. And then you would learn kind of hands on, because this was considered a very manual, practical trade. Uh, it was very much like butchering and less like being a doctor in those times. But instead, J. J. Lister wanted his son to take more of the route of a gentleman physician. Um, which is go to college and then go to medical school. And Joseph himself agreed with this. He agreed that having a more well rounded education would be better overall. Arpita: 11:34 Yeah, that makes sense. I, sorry, back to your manual labor comment. I was just thinking, so when I was in grad school, I had the opportunity to watch a knee surgery. It was something fairly routine, like a knee replacement. Aarati: 11:51 Okay. Arpita: 11:52 I have to say that at least for orthopedic surgeries or anything involving the bones, it is straight up carpentry. Like, it's bone saws hammering, chiseling, like basically pounding metal into place. It is quite manual. And so I can only imagine what it was like in the early 19th century. Aarati: 12:10 And you had to do it fast too, now at least we can kind of take our time, make sure we're not Making any mistakes but there it's like the patient is screaming and flailing around and you need to get this done fast So Arpita: 12:23 that is insane. Okay, so he's going to medical school... Aarati: 12:25 So he decides to go yeah to medical school but his options for universities were limited because he was a Quaker and he couldn't go to universities like Oxford or Cambridge because they imposed something called a religious test So like you were mentioning in the last episode with William Buckland These institutions are deeply entrenched in the Church of England's teachings, so if you aren't part of the Church of England, you're barred from studying or getting your degree there, so Arpita: 12:55 Yeah, and are Quakers the, not, they're very non violent, right? That's their That's their philosophy also. So I'm interested to see how that fits into his surgery dreams. If it's about, not hurting people and not violence. Aarati: 13:08 Oh yeah, so I think it actually does play a role later on. I'll talk about it a little bit. But that's definitely a good point. Um, so, because he can't go to Oxford or Cambridge, he ends up going to the University College London Medical School, which was a relatively new school at the time that was founded to have a bit more religious freedom, and so they accepted Quakers. At UCL, Joseph pursues a Bachelor of Arts in Classics and studies things like math, Greek, anatomy, and atomic theory. During this time, he also attended a hugely monumental landmark operation done by a well known surgeon named Dr. Robert Liston, where a patient was successfully anesthetized using ether for the first time in England before undergoing surgery. Arpita: 14:00 What is ether? Aarati: 14:01 Ether is, it's like a gas that you breathe in, and I guess it knocks the patient unconscious, Arpita: 14:07 Okay, and you wake them up? Aarati: 14:08 I think eventually, you just like, So you leave, uh, Either a mask or a rag or something of ether On the patient's face while you're operating on them. And then you take it off, and then after a while of breathing, just normal air, it'll dissipate from your bloodstream or something, yeah. Arpita: 14:24 I see, I see. Okay, and so this was a very landmark procedure that he got to watch during his undergrad. Aarati: 14:30 Yes, um, and it was a huge turning point in surgery, and Lister recognized that, because it's like the first time of having a reliable, safe way to knock out patients, and that meant that surgeons could now take their time and do things more carefully. Arpita: 14:46 Right. Aarati: 14:47 With more precision, and also, the patient wasn't scared or in pain, which was very big for Lister. Arpita: 14:54 Important. Aarati: 14:54 Yeah, he, he really felt for his patients, so, um, that was a big point for him. Arpita: 15:00 Yeah, like a normal person, yeah. Yeah, Aarati: 15:03 But this was a good thing and a bad thing, At the time, because, reminder, we are just at the beginning of the Industrial Revolution. So there's a lot of industry and construction related accidents happening and now with this new way to anesthetize patients more perhaps less qualified people are feeling confident that they can be surgeons now and make a career out of it because now it doesn't seem so scary or You know, you don't have to have such an iron stomach to do it Arpita: 15:34 Totally and it back to the original point that you don't need to be specially trained or qualified to become a surgeon you sort of anyone can do it as long as you're up for it and maybe have a semblance of hands on training, but it does seem sort of generally open. Aarati: 15:50 Yeah, it really does I was reading in one source that like you could definitely have an illiterate surgeon who's doing like your operation. Arpita: 15:58 Oh my god Aarati: 15:59 But back to Joseph. So he's watched this landmark operation, which was, very, inspiring to him. But overall, school proves to be a bit of a tough experience for him. He was a brilliant and excellent student, but he was also a very shy and introverted kind of person in general. And he was also deeply empathetic. So partway through his BA, when his older brother tragically died of a brain tumor, Joseph felt that loss very deeply. And around this time Joseph also contracted a mild case of smallpox, and although he recovered, the combination of his brother's death, plus his own close brush with death, made him wonder if it was even worth pursuing a medical degree, because at the time, like, both a brain tumor and smallpox were incurable, like, even Arpita: 16:54 Right. Aarati: 16:55 Even with a way to anesthetize patients, you couldn't operate on a brain tumor at the time without killing the patient, and there's no cure for smallpox, so like, what even is the point of going into medical school, getting a medical degree, um, Arpita: 17:10 If you can't prevent all of these things that almost to him must have seemed so pervasive, right? Like so common it was his brother, then him, it seemed everywhere. So what's the point? Aarati: 17:20 Yeah, exactly. And so because of that, he ended up having kind of a nervous breakdown and sinking into a deep depression. Arpita: 17:27 Poor guy. Aarati: 17:28 Yeah, and for a while he considers abandoning his idea to become a surgeon altogether and thought that maybe this was God's way of telling him that he should turn into a more religious calling and become a minister. But he wrote all this to his father and his father wrote back and said, Well, take take a deep breath. Um, take some time off and think things through a little bit don't be too hasty with your decision. So He takes that advice. Arpita: 17:54 He sounds like a good dad. Aarati: 17:55 He's such a good dad. Arpita: 17:57 JJ sounds like such a good dad. Aarati: 17:59 They, they're, they're so like, they're such a good father son dynamic. Arpita: 18:04 Yeah, this sounds very cute and very sweet. Aarati: 18:07 So in December 1847, Joseph graduates with a B. A. with a distinction in classics and botany. And then after that for about a year, he takes a break to travel around Europe with his friend, John Hodgkin, who is nephew of the famous Dr. Thomas Hodgkin, who first described Hodgkin's lymphoma. So that is just a random little tidbit. The two families were friends. Arpita: 18:32 Yeah, that is really interesting. I mean, This might be an entirely separate episode, but lymphoma is, uh, blood cancer. And so I wonder if it's somewhat related to then JJ's interest in histology and cells. Aarati: 18:44 Yes, it absolutely was. Arpita: 18:45 And so now there's the microscope. Okay. Aarati: 18:47 Yeah, it absolutely was. I read that they would, talk about it. Like, You know, Hodgkin would give, J. J. Lister samples of blood and they would look at it under the microscope and discuss the shapes that they saw and things like that, so. Arpita: 19:00 That's super cool. Aarati: 19:01 Yeah, definitely. After his year abroad, Joseph once again finds his passion for medicine and surgery. So now he's feeling a bit refreshed and starts medical school. And he continues to excel academically. So I just want to say, he's just brilliant. He's overall, he wins all the awards. He's the student that you hate who's always at the top of his class, you know, you can't hate him because he's also so nice. Arpita: 19:28 He's so nice. Yeah. Aarati: 19:30 Yeah. Arpita: 19:31 So probably the nicest guy. He also seems like he has a brilliant dad and a brilliant friend in Hodgkin. Aarati: 19:39 Yeah. Arpita: 19:39 So it does seem like they're all surrounded by really, really wonderful, but also... Aarati: 19:45 yeah. Arpita: 19:45 ...intelligent people. Aarati: 19:47 Overall, just very heartwarming. Everybody is just like the best person in this story. Arpita: 19:52 Yeah, this is this is very cute and wholesome. Aarati: 19:54 Yeah, so as part of his medical degree, Joseph also had to do two years of residency at a clinic at the University College Hospital. So Joseph starts working under Professor John Eric Erichsen, first as a dresser, and that's someone who monitors patients who are recovering from surgery and carrying the surgeon's tools around while they're operating and things. And then eventually he becomes a house surgeon who's in charge of his own patients. During his time here, Joseph makes some key observations. The first big one was when a patient who had erysipelas, which is a bacterial skin infection, came into the surgical ward. Until then, this hospital had been running along fine, no infections, but this guy with his infection was left in the ward for just two hours. And then all of a sudden, twelve patients came down with infections and four died. Arpita: 20:49 Oh, wow. Aarati: 20:49 Yeah. And very importantly, what Joseph noticed was that the patients who had the worst infections were the ones with the most recent surgical wounds. Whereas patients whose wounds had started to heal or were already mostly healed and the wounds had closed up, they escaped the infection for the most part. So Erickson believed in something called the miasma theory, which is now discredited. But at the time, a lot of people bel Ooh, there goes my microphone. Okay. But at the time a lot of people believed that wounds or rotting flesh would exude bad air and that other patients would breathe that in causing them to get infected. So, they thought the air itself was bad, and I read another way you could think about this is that if the miasma theory were true, people would gain weight just by smelling food. Arpita: 21:43 I see. This almost reminds me of, sort of in Eastern medicine, the qi, so if there's like an energy around you that you give off to other people, that's what it reminds me of. But yeah, I guess there's some truth. I have to say you saying rotting flesh did give me goosebumps, but let's continue. We're going to go past that. Aarati: 22:02 Like I said, I, I'm not squeamish, so I don't catch things. Arpita: 22:06 You just said rotting flesh so casually and I'm like, Aarati: 22:12 I'm really sorry. I'm gonna, I'm trying. Um, but because of this, hospitals would sometimes be aired out during the day to get rid of the bad gases, but nothing was really required to be cleaned or sanitized as such. But Joseph was starting to realize that maybe there was something more to how infections were spread. First was his observation, of course, that patients with healed wounds were less likely to get sick, um, which didn't fit with the miasma theory. And then, another time, there was a patient in the ward with a very bad case of gangrene, and Joseph took some of the gangrenous tissue and put it under his microscope and saw little things that he couldn't identify. And it sounds like what he was actually seeing were the microbes that were causing the gangrene, but he of course didn't realize that yet, because germ theory wasn't a thing yet. Arpita: 23:07 Right. Aarati: 23:08 For now, he just drew them, and he put a pin in it, and observed. During this time, Joseph also did a couple of other pretty remarkable things. In addition to publishing his first two scientific papers, he also did his first solo operation on a woman named Julia Sullivan, who had been stabbed in the abdomen by her abusive, drunk husband. Arpita: 23:30 Oh my god. Aarati: 23:31 Joseph ended up removing part of her intestine and suturing up her wound. She recovered really well and bonus, her husband was caught and went to trial for attempted murder. Joseph gave testimony at the trial regarding Julia's injuries. And that helped land her husband a guilty verdict, and he was shipped off to a penal colony in Australia for 20 years. Arpita: 23:54 Oh, good. Okay, great. So he's gone. Aarati: 23:55 Yeah. Arpita: 23:56 But that's amazing, though, the surgery. That it not only went well, but it was not a limb to lob off. It was actually her abdomen and that feels way riskier given the situation that you're describing. The fact that she healed well, like, that's amazing. Aarati: 24:11 Yeah, it definitely, at the time, like any surgery that involved anything With the head or brain or your torso or your abdomen, that was kind of like you're not going to live through that. I'm sorry, you know. Arpita: 24:25 For sure, yeah. Aarati: 24:26 Um, so yeah, you're right. That was pretty amazing that it went well and she recovered. So, finally, after nine years of higher education, Joseph graduates in 1852 with a ton of medals and awards, again, he's brilliant, including two out of the four available gold medals for anatomy and physiology, and the Longridge Prize. At this point, Joseph is still kind of wondering what to do with his degree now. Should he go into surgery? Or, since he did get an education, he could still take the path to becoming a gentleman's physician. One of his physiology professors named William Sharpey, noticed this and suggested that Joseph go spend some time with Sharpey's lifelong friend, James Syme. I believe it's Syme. It could be Sim. I'm not sure. I'm gonna say Syme Arpita: 25:17 Sounds right. Yeah. Aarati: 25:19 In Edinburgh. Syme was considered one of the best clinical surgeons in the UK at the time. One of his biggest claims to fame was an amputation at the hip joint that he did in under one minute. Arpita: 25:30 What? Aarati: 25:31 Yeah. Just take off that leg. Arpita: 25:33 How is that even possible? Aarati: 25:34 Took a minute. Arpita: 25:35 Just like, just pull it off. Aarati: 25:37 Yep. Just take it off. Um, he had also developed, what is still known today as the Syme amputation, which is where you remove part of the foot at the ankle joint. Arpita: 25:49 Right. Aarati: 25:49 So that the heel of the foot is maintained and the patient could still use it to walk. Arpita: 25:54 Yeah. I, yeah, I forgot about that. Aarati: 25:56 Yeah, so, is it Syme then? Is that how you...? Arpita: 25:59 I think it is Syme, because that's how I used to say it. But I do remember learning about that. It's like where you cut off, it's like an ankle surgery, right? And then they also don't have their toes. Isn't that right? Aarati: 26:10 Yes, correct, yeah. But before they would either cut off, like if there was a problem with your foot or your ankle, they would cut off your leg either just below the knee, or at the knee, so that you didn't have that limb to walk on, but he developed a way that you could actually still keep your heel and still use that to walk. Arpita: 26:31 You could still have something to walk on. Aarati: 26:32 Yeah, so that was groundbreaking. So, Sharpey said you should go spend some time with him, Joseph was welcomed with open arms by Syme and started a surgency appointment at the University of Edinburgh So his time with Syme was really only supposed to be for one month, but one way or another, Joseph kept finding reasons to extend it because he was learning so much. Arpita: 26:54 Yeah. Sounds like he had, more opportunities, too. Aarati: 26:56 Yeah, he was, getting to deal with so many more patients. He was learning a lot from Syme himself, so he just kept finding ways to stay there longer. But another reason he might have wanted to stay there longer was because he had started to become very attracted to Syme's daughter, Agnes. Arpita: 27:13 Nice. Aarati: 27:14 Yes. So, she was very smart, she was warm hearted, and since her father was a famous surgeon, she was familiar with a lot of the medical practices. One snag though, Joseph's parents were a bit concerned because Agnes was not a Quaker, nor did she want to become one, which meant that Joseph would have to leave the Quaker community if he married her. But his parents told him that they would still support him, you know, financially and emotionally and whatnot, no matter what he decided to do. So Joseph did decide to leave the Quakers in order to marry Agnes. So in 1856, they got married in Syme's house, and for their honeymoon, they spent some time in Upton with Joseph's family, and then three months touring medical institutions all around Europe. Arpita: 28:03 What are these extended honeymoons like this sounds amazing Aarati: 28:07 and also like the same thing with Buckland they're just doing more science on their honeymoon they're just Arpita: 28:13 yeah it's like two questions one they're just touring the world for months at a time I would like to do that and number two are using their honeymoons so productively. I'm out here being like, should we go to the Maldives? Should we go to Hawaii? Not have a thought in my brain. Yeah. Aarati: 28:32 Not think about things. Arpita: 28:33 Good on them. Aarati: 28:33 Yeah. But yeah, it was a really good match overall. From that point, Agnes became Joseph's partner in life and the lab. She took notes for him and left spaces in the notebooks for his microscope drawings and would discuss his work on the same level as him. Yeah, so super, super cute. So after a year working with Syme, Joseph was trying to figure out what to do next when a surgical lecturer at the Edinburgh Extramural School of Medicine happened to pass away from cholera. So with Syme's support, Joseph was able to take over that vacant position as lecturer, and he was able to continue doing scientific research as well. Arpita: 29:13 Oh, that's really cool. Aarati: 29:14 Yeah, so over the next three years, from 1856 to 1859, Joseph published 15 papers. Arpita: 29:23 Oh my god, that's so many. Aarati: 29:25 In three years. Arpita: 29:26 Wow, that's hugely impressive. Aarati: 29:28 The papers were mostly on inflammation and how blood coagulates, but also some on nervous system control of your arteries and organs, later, Joseph said that this work, especially on how inflammation starts, was an essential preliminary to his work in developing his antiseptic principle. And to cap it all off, in 1856, he was unanimously voted to take on the position of assistant surgency at the Edinburgh Royal Infirmary, so... doing well. Arpita: 29:57 Wow, yeah, so it does seem like he's there to stay. Aarati: 30:00 Well, so then, in the next sentence, yeah, so, yeah. So then in August 1859, Joseph learns that one of the chairs of surgery at the University of Glasgow, Professor James Adair Lawrie, was ill and close to death. And Joseph saw this as an opportunity. If he could fill that position, he would be able to make a higher salary, conduct more surgeries, and create a bigger private practice. So, Syme, William Sharpey, and Eric Erichsen all wrote letters of support for Joseph. And when Professor Lawrie died in November, Joseph was confirmed to take over his title as Regis Professor of Clinical Surgery. Arpita: 30:46 How old is he at this point? Aarati: 30:47 Um, I'm not sure. When was he born? He was born in 27, it's now 59. So, 32? Arpita: 30:56 That's amazing. I mean, I guess They're probably not living as long, but that's still really impressive. Aarati: 31:02 Yeah. Arpita: 31:03 How old we are now. Aarati: 31:04 I know. I'm older. I have not done nearly half the things. Oh my god. Okay. Arpita: 31:13 Yeah, we have a podcast. It's the same. Aarati: 31:17 Yeah, exactly. Okay, so shortly after this, Joseph was also elected to be a member of the Royal Society because of his work on blood coagulation and inflammation, which thrilled his father because now they're both part of the same prestigious scientific organization, so it's like, yay! Arpita: 31:35 That's amazing. Aarati: 31:36 Father and son bonding. Joseph and Agnes moved to Glasgow, but weirdly enough, he was not able to practice surgery, just give lectures on it. If he actually wanted to perform surgery, he had to get an appointment as a surgeon to the Royal Infirmary. Arpita: 31:53 I see. So it wasn't exactly what he was expecting. Aarati: 31:56 Yeah. He, I think he thought that the lecturing position would naturally be tied to a position at the Royal Infirmary, but it wasn't, for whatever reason. So since he had no patients to take care of when he first got there, Joseph focused entirely on lecturing his students, and they loved him. And the main reason for this is that he was, again, just a very kind, empathetic person in general. Arpita: 32:22 It sounds like I think of someone who's very, like, gentle and soft spoken and non violent and kind. Sounds like it fits everything that you're saying. Aarati: 32:32 Yeah, that basically was him to a T. He really cared about his patients and his students. When dealing with patients, he would try his best to make them feel calm and comfortable, which was something that many of his other colleagues didn't really care about, especially if the patient was poor. But Lister, didn't care what your background was. He was like, we need to treat everybody the same, whether they're the Prince of Wales or a beggar on the street. It doesn't matter. He would study different types of anesthetics like ether versus chloroform versus nitrous oxide and see how it affected the surgery and the patient's state of mind after they came out of its influence and see what made the patient more comfortable and gave them a better outcome. So he really just cared about Everything and everybody, um, and that was the same sort of care he brought to his students and his lectures and that's why they loved him so much. Arpita: 33:29 Yeah, it makes sense There's like a lot of overlap you're you know meeting someone when they're no less than you and you have this power over them in both situations but you're able to meet them where they're at. It does it does make sense that it had a lot of overlap and he was really good at both Aarati: 33:44 Yeah, so in november of 1860 when the winter lecture course began 182 students out of 311 registered, which is over half, signed up for Joseph's class, which was, quote, the largest class of systemic surgery in Great Britain, if not Europe. Arpita: 34:03 Wow. Aarati: 34:04 Yeah. Some of the students even made him the honorary president of their medical society. And when Joseph was struggling to get an appointment at the Royal Infirmary so he could actually practice surgery, um, and the reason he was having trouble getting an appointment there was because many people on the hospital board deemed Lister to be too progressive, Arpita: 34:25 Mm hmm. This makes sense. Aarati: 34:27 Yeah. So 161 students signed a petition on his behalf to get him a position there. Arpita: 34:33 It sounds like, unanimously, people just, or his students at least, just loved him. Aarati: 34:37 Yeah. And so after a year, Joseph became the chief surgeon at Glasgow's Royal Infirmary and was in charge of two hospital wards and he could finally start performing public teaching operations and start conducting surgical trials. Arpita: 34:53 I forgot these were public. Aarati: 34:54 Yeah. Yeah, it's just still, still not good. So Life is going pretty well in Glasgow, but Joseph is still very frustrated by the fact that he can't seem to control people getting infections and dying after the surgery, no matter what he does. Until one of his colleagues, a professor of chemistry named Thomas Anderson, asked Joseph, Hey, have you read these papers by this French chemist, Louis Pasteur? Arpita: 35:20 Louis Pasteur! Aarati: 35:22 Yes! I think you'd find that interesting. So, Joseph reads Pasteur's famous paper from 1861, where Pasteur disproves spontaneous generation. He takes two flasks of, nutrient rich broth. And one flask just has a normal, like, straight neck. And the other one has this curvy, S-shaped neck. And he boils the broth in both flasks to kill anything that might already be in there. And then he just leaves the flasks alone. And then after a while, the flask with the straight neck is all cloudy, indicating microbial life. And the flask that has the S- shaped neck is clear, because any dust or microbes that would have tried to enter the flask would get caught or trapped in that S- shaped curve, and couldn't reach the broth. So, Pasteur concludes that life doesn't just spontaneously start, it had to start from a spore. So in other words, life must come from life. There were a lot of scientists who were skeptical about Pasteur's findings at the time, but for Joseph, that was like a light bulb going off. He's like, finally, here's the simple answer I've been looking for. It made sense with all the things he had observed up to this point about how infections were spreading, what he had been seeing under the microscope when he took tissue samples from patients, Arpita: 36:42 yeah, these like unidentified things on the microscope that he didn't know what they were. Aarati: 36:46 Yeah, he's like, oh, that's those little spore things that Pasteur is talking about. Must be. Arpita: 36:52 Right. Aarati: 36:52 So it made sense then that if you wanted to stop a wound from getting infected, you had to stop these microorganisms from entering the wound. And Pasteur had even provided three methods of how you could prevent microbes from starting to grow, either filtration, exposure to heat, or using chemicals to kill the microorganisms. Arpita: 37:12 Yeah, those seemed like good starts. Aarati: 37:14 Yeah, so Joseph was like, okay, we can't do the first two with, um, patients. So He started looking for chemical solutions that he could apply to the wounds to keep the microorganisms away. It's a fair point to note that a lot of surgeons had been trying different antiseptic, solutions on wounds but with very little success, mostly because they didn't, do it properly or they didn't keep up with it properly. They just kind of like tried it but not with any real method Um, but there were a few like antiseptic solutions that people had been trying. The one that Lister had the highest hopes for was carbolic acid, which is also known as phenol. So he first tried an undiluted raw form of carbolic acid called creosote, which was used to preserve wood on ships and railways. He soaked a piece of linen in creosote and laid it across the wound and plastered it up, but that didn't really work well and the patient eventually died of an infection anyway. Um, not only was the way that the creosote was applied very clumsy, but creosote itself is also skin irritant, so that would cause lesions, so that's not good. Yeah. Arpita: 38:27 Oh god, okay. Aarati: 38:28 So, Joseph was like, okay, that didn't work, so he decided he needed to obtain a more pure and clean form of carbolic acid, uh, which he did from a chemistry professor at the Royal Manchester Institution. In August 1865, he finally achieved what he had been hoping for. A young 11 year old boy named James Greenlees had been run over by a cart and sustained compound fractures in his left leg. So, normally a surgeon would have taken one look at an injury like that and just been like, the leg has to go. Amputation time. Arpita: 39:03 Cut it off. Aarati: 39:04 Yeah. Arpita: 39:04 Yeah. Aarati: 39:05 But Joseph made the split second decision to try and save the boy's leg using his carbolic acid treatment to prevent infection. And again, partly because he's so empathetic. He was like, well, this boy's 11 years old. If I cut off his leg, he's going to be relegated to a second class citizen for the rest of his life. He's not going to be able to do anything. Arpita: 39:24 Yeah, that's true. Aarati: 39:24 You know, so, but if I can save his leg, then he might go and have a normal life. So he's like, let's try that route. So he washed and disinfected the wound using a piece of cloth dipped in carbolic acid mixed with olive or linseed oil to soothe the skin because carbolic acid is still kind of irritating he changed that cloth daily, and after six weeks, he was amazed and excited to see that James bones had fused back together with no sign of infection, and soon he was able to walk out of the hospital. Arpita: 39:58 Wow, that's amazing. Aarati: 39:59 Yep, he did it. So he kept doing this with patients that came in with compound fractures over the next few months with excellent results. And then nine months later, he finally tried it with an actual surgical patient, a 21 year old man named John Hainy, who broke both bones in his shin in an accident at the iron foundry where he worked. Joseph bound the wound in a cloth dipped with carbolic acid. A few days later he wrote to his father that quote"I tried the application of carbolic acid to the wound to prevent decomposition of the blood And to prevent the fearful mischief of suppuration" Arpita: 40:39 "Fearful mischief"! Aarati: 40:42 I love this. I love this. Why don't we talk like this anymore? Arpita: 40:47 I know! Why don't we talk like this. Aarati: 40:49 The fearful mischief of suppuration. It is now eight days since the accident and the patient has been going exactly as though the fracture were a simple one. End quote. Arpita: 41:00 Yeah. It's like, amazing. Like, he went from everyone dying, well not his patients clearly, but like, everyone was like kind of hopeless. Like, it felt like a shot in the dark. And now it feels like more consistent and he's getting really consistent results. Aarati: 41:12 Yeah. Exactly. Also in 1867, Joseph's own sister, Isabella Sophia, was diagnosed with breast cancer. She had looked for a surgeon, but no one was willing to operate on her And, in fact, this would be the first ever radical mastectomy ever recorded. So, yeah, Joseph couldn't refuse his own sister, um, so he agreed to operate on her. He was like, better me than anybody else, I guess. They decided to carry out the operation in Joseph's own home on his dining table, because he was afraid that Isabella would have more chance of catching an infection at the hospital. Arpita: 41:51 I mean, like, he's not wrong. Aarati: 41:52 Yeah. So, I was just like, oh my god. And back then also, like, having an operation in your own home was something that only rich people could afford. So it was better to have the operation. If you could get a surgeon to come to your house, that was more desirable than you going to a hospital. Arpita: 42:11 Sure. Aarati: 42:12 Yeah. So Joseph and three other surgeons cleaned everything, including the surgical tools with carbolic acid before the operation. The operation went well and Isabella healed without any infection. Arpita: 42:23 So this is sterilization. Like, he's basically learning that sterilizing all your tools and your equipment is the best way to prevent this stuff. Aarati: 42:30 Yes, exactly overall, Joseph tried out his new method on 11 surgical patients, 9 of whom recovered. So that was just an astounding recovery rate for the time. Arpita: 42:42 Yeah, that's huge. Aarati: 42:43 Yeah, before this, it was like 50 50 chance that you would die if you underwent surgery. Like literally tossing a coin. But Joseph took that to an over 80 percent chance of survival just through using antiseptics and disinfectants. to sterilize everything. So, although it was a small sample size, which Joseph himself acknowledged at the time, it was still very impressive. Arpita: 43:08 Very impressive. Aarati: 43:10 In 1867, Joseph published an article called"On a New Method of Treating Compound Fracture, Abscess, etc., with Observations on the Conditions of suppuration" in The Lancet. Arpita: 43:22 Etc. I love that. Aarati: 43:23 Yeah, etc. Just Compound fracture, abscess, etc. Arpita: 43:27 You just like submit your paper with etc. Aarati: 43:29 Yeah. Arpita: 43:31 And whatever else I think of. Aarati: 43:32 Whatever else. Yeah. In this paper he described how large wounds like fractures would become inflamed, which was a necessary part of the healing process. But this was also the most likely time for tissue to start decaying and infections to set in. So unlike smaller wounds like small cuts that would scab over quickly, large wounds would become inflamed with dead tissue and cells which could lead to rotting. Arpita: 43:59 But that, that's actually, I feel like, a very advanced point that he isn't looking to prevent inflammation altogether. He's looking for a way that it's able to happen but safely. And that feels like A very big jump that you're able to understand that inflammation to a certain extent is needed for tissue healing. Aarati: 44:21 Yes, it was a very big statement to make because at the time a lot of people were still wondering if inflammation was part of the infection starting to happen or if it was just a natural process that needed to happen in general. So for him to say it's the latter. Arpita: 44:38 Yeah. And it looks bad, right? It's like red and hot and swollen and you get all of these things and you don't feel good as a patient and it seems like it's pointing to the direction of, you know, tissue damage and not recovering. But for him to make this claim is huge. Aarati: 44:55 Yeah, like inflammation is a natural thing, but we don't need to let infection set in after that. Arpita: 45:02 Right. Aarati: 45:02 So they're two separate things. Here he also made the statement that he's most famous for, which is the decomposition of organic tissue was caused by quote"minute particles suspended, which are the germs of various low forms of life long since revealed by the microscope and regarded as merely accidental concomitants of putrescence." Arpita: 45:24 Okay, so he's basically saying that there are small things in the air and around you that can be seen on a microscope that are causing this and it's not happenstance. Aarati: 45:36 Yeah, and with this statement he's also fully throwing his weight behind Pasteur and his germ theory. Arpita: 45:42 Right. Aarati: 45:43 Yeah. He then describes how when carbolic acid is applied to a wound it forms a crust over the wound kind of like a big scab that prevents germs from entering and causing an infection so That process happens naturally with a small wound, but you need carbolic acid to do that with a big wound. Arpita: 46:02 Do we use carbolic acid now? No, right? Aarati: 46:04 Uh, no. So, I looked up somewhere what, what, antiseptics we use now, and it's things like iodine, um, Yeah, like Arpita: 46:15 betadine or something. Okay, got it. Aarati: 46:17 This all formed the basis for Joseph's seminal article,"Antiseptic Principle of the Practice of Surgery", and there are two unique ideas that he put forward in this paper. The first was that infection was due to germs, and the second was the method to prevent infection. So like I said, people have been trying antiseptics for a while. But they weren't really being executed properly or consistently So Lister laid out an actual like protocol for surgeons to follow including wearing clean gloves, washing their hands with the five percent carbolic acid solution before and after operating, sterilizing the operating instruments and wiping down the operating room. Arpita: 46:56 I mean that's like a really solid protocol, he really covered all of his bases, and also just from a scientific point of view, it seems really interesting that he not only identified a problem, but then also wrote a protocol to address it. Aarati: 47:09 Yeah. But at the same time, I think. It was a little bit much for the scientific community or the medical community. Arpita: 47:18 Sure. Aarati: 47:18 Not only are you saying that wounds are caused by germs, which we're still not 100 percent on board with. Arpita: 47:26 But like convinced on. Aarati: 47:27 Yeah, but now you're introducing this new like protocol or method that you're, we're supposed to do before every surgery to prevent so called germs, which we don't know if we actually still believe in, so it took a while for people to get on board with what was called"Listerism" at the time. There were quite a few. Prominent scientists who did not believe in Pasteur's germ theory, and that was the heart of Joseph's antiseptic method. Arpita: 47:55 Right, it's really like the crux of it, he has basically put all of his, all of his cards with Louis Pasteur and saying that like, based on this work, here's all of my stuff. Aarati: 48:05 Yeah, For a while, Listerism was actually banned in many hospitals, including the U. S. Because people thought it was too complicated and wasted time. Arpita: 48:15 I could see that perspective too. Aarati: 48:16 Yeah. but Joseph did have quite a few allies, including his students, who loved him. And they basically went out and became sort of medical missionaries for the antiseptic method because they had seen it firsthand and what it could do. Arpita: 48:29 It's so sweet. Aarati: 48:31 And Louis Pasteur was also one of his advocates, so Joseph and Louis Pasteur actually became friends, and Joseph always gave credit to Pasteur for laying the foundation of germ theory and said that the practice of surgery owed a great debt to Pasteur. Arpita: 48:48 Wow, we love that. We love scientist crediting each other. Aarati: 48:51 Yes! The height of collaboration, so it took a few years, but slowly but surely the impact of antiseptic practices became impossible to refute. Surgeons and scientists would visit Joseph to learn his practices and then teach them to their students. Uh, One of Joseph's biggest advocates was Richard von Volkmann, who was a surgeon general during the Franco Prussian War. He oversaw 12 army hospitals and over 1, 400 patient beds. Before he started using Joseph's methods, he wrote that the number of people dying from quote unquote blood poisoning was so great, he thought it would be best to just close the facility because they had nowhere to keep all the dead bodies. Arpita: 49:34 Oh my god. Aarati: 49:34 I know. But after employing the antiseptic practices, he wrote, quote,"Since autumn of last year, 1872, I have been experimenting with Lister's method. Already the first trials in the old contaminated house show wounds healing uneventful without fever and pus." Arpita: 49:53 Yeah, that's huge. Aarati: 49:54 Amazing. He employed Lister's method and just did a total 180. So, once people really saw the incredible change in the recovery rates that Joseph's methods provided, he was given all the celebrations, banquets, medals, awards, like, everything. Like, everyone was like, you're amazing. People rolled out the red carpet for him because he was responsible for saving so many people's lives. Arpita: 50:20 Right, right. Aarati: 50:21 By this time, Dr. Syme had passed away, making Joseph now the most renowned surgeon in the UK. He was knighted and appointed Surgeon Extraordinary to Queen Victoria herself, and then once she died, he was reappointed to her son and successor, King Edward VII, in 1902. And two days before the coronation, Edward VII had to have an appendectomy, which at the time was still regarded as a highly risky surgery. So, Edward VII's surgeon consulted Joseph about the surgery, and He survived. Later, King Edward VII told Lister,"I know that if it had not been for you and your work, I wouldn't be sitting here today." Joseph died at the age of 84 in 1912. His funeral was a large public affair that was held at the Westminster Abbey. He was buried in Hampstead Cemetery, and a marble medallion of him was placed at Westminster Abbey along with four other notable scientists, Charles Darwin, George Stokes, John Couch Adams, and James Watt. Arpita: 51:28 That's like, really like, distinguished company. Aarati: 51:33 Mm hmm. Very distinguished. The Lord Lister Memorial Fund was also set up in his honor by the Royal Society, and that led to the founding of the Lister Medal, which is one of the most prestigious awards a surgeon can receive, even today. So over the past hundred years, only 27 people have received the Lister Medal. Arpita: 51:55 How do you get the Lister Medal? What do you, what's the...? Aarati: 51:58 Some huge breakthrough or advance in surgery, I guess. Arpita: 52:02 In surgery specifically? Got it. Aarati: 52:04 In his will, Joseph had written that he wanted all of his scientific manuscripts and sketches to be destroyed because he thought they wouldn't be of any value. Arpita: 52:15 Oh no. Aarati: 52:17 Thankfully, that was the only request in his will that his family did not fulfill. And Arpita: 52:22 okay, good. Aarati: 52:23 Yeah, I wanted to read this quote from that book I mentioned earlier, Lindsay Fitzharris's book. Because I thought it was not only true of Lister's life, but also probably everyone in this podcast that we will be discussing or that we have discussed. She puts it so eloquently. She writes,"Lister wrongly believed that his personal story had little bearing on his scientific and surgical achievements. Ideas are never created in a vacuum, and Lister's life very much attests to that truth. From the moment he looked through the lens of his father's microscope to the day he was knighted by Queen Victoria, his life was shaped and influenced by his circumstances and the people around him." Arpita: 53:02 That's such a good quote. I love the way that she put that because I think it It looks at where he comes from, not only, you know, where he was born, but his parents and his family's influence, which, for better or for worse, we all have, and I think that, he's like the product of his circumstances, like, that is so simple, but true. Aarati: 53:26 And all the people he met along the way, like all his professors who told him, like, hey, you should You seem like you're floundering a bit. You should go, you know, do a surgency appointment with my friend, or like, hey, have you read this paper? Or like, you should read this. Arpita: 53:41 Right, or even his, like, students who supported him from, you know, just like his, they just loved him and... Aarati: 53:49 You can't do this alone. It never happens, you never can do things like that alone. And I think a lot of people... Arpita: 53:54 and his wife taking notes for him. Aarati: 53:56 I know. I mean... Arpita: 53:58 so cute. Aarati: 53:59 Yeah, people think a lot of times that scientists are just these brilliant people who just have these extraordinary ideas one day out of the blue. Joseph Lister was brilliant, but he needed help, too, you know? So Joseph's legacy lives on even today. It's given in any hospital in every surgery room that everything from floor to ceiling including the people and the surgical tools have been completely sterilized. Thanks to him having a broken bone or routine surgery like an appendectomy is no longer a 50/50 death sentence. Yeah, and also because of Joseph's work people suddenly started becoming obsessed with hygiene. So all of these home cleaning and personal hygiene products started to enter the market. So we already mentioned Listerine, which, um, was developed in 1879 by Joseph Lawrence. He was a chemist in St. Louis, and he developed it as an antiseptic for surgeries originally, but eventually it was promoted to dentists, and now we know it best as the over the counter mouthwash. But also, his, lectures and his influence also led to the founding of the company Johnson & Johnson, which of course is still around today. Apparently, the founders were in, the audience of one of his lectures and were inspired to start this company of hygienic products. Arpita: 55:27 Wow, that's amazing. And and now it's this huge conglomerate, but it really is so well known for, you know, household cleaning, soaps, personal products, all of these things. So that's very cool. Aarati: 55:37 So his influence is everywhere today, so. Arpita: 55:40 Yeah. Aarati: 55:41 Yeah. So, I mean, that's the story. Arpita: 55:44 Well, I guess that's a wrap on this episode. Aarati: 55:47 Yeah. Thanks for listening, everybody. Arpita: 55:50 If you have a suggestion for a story we should cover, or thoughts you want to share about an episode, reach out to us at smartteapodcast. com. Follow us on social media, and listen to us on Spotify, Apple Podcasts, or wherever you get your podcasts. New episodes are released every other Wednesday. See you next time!

Sources for this Epsiode

1. Fitzharris, Lindsay. "The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine." Scientific American/Farrar, Straus and Giroux. 2017. 

2. "Joseph Lister". Wikipedia. 

3. "Joseph Lister: British surgeon and medical scientist". Written by Frederick F. Cartwright. Encyclopedia Britannica. 

4. Richardson R, Rhodes B. "Joseph Lister's first operation." Notes Rec R Soc Lond. 2013 Dec 20;67(4):375–85. doi: 10.1098/rsnr.2013.0033. Epub 2013 Jun 26. PMCID: PMC3826195.

5. Roberts WC. "Facts and ideas from anywhere." Proc (Bayl Univ Med Cent). 2018 Apr 11;31(2):257-267. doi: 10.1080/08998280.2018.1441481. PMID: 29706840; PMCID: PMC5914394.

6. Godlee, Rickman John, Sir, "Lord Lister". London : Macmillan and co., limited, 1918. 

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