Joseph Lister, X-rays and nursing – how Glasgow Royal Infirmary changed medicine

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PREMIUM

WHEN an 11-year-old boy suffered potentially life-threatening crush injuries to his leg after falling under the wheels of a cart on Castle Street, in front of Glasgow’s Royal Infirmary, he inadvertently triggered a watershed moment in medicine.

It was August 12 1865 and the youngster, James Greenlees, was admitted to the male accident ward where renowned Glasgow University professor, Joseph Lister, was then the house surgeon.

The 38-year-old Englishman was fascinated by the theories of French scientist Louis Pasteur, who had suggested that tiny organisms infecting the blood during surgery might explain why half of patients became sick and died following operations.

At the time most medics believed that diseases such as gangrene and sepsis were caused by ‘miasma’ – a poisonous vapour of decaying particles suspended in the air.

Lindsey Fitzharris on life, death and surgery in the 19th Century

Lister was convinced that germs were the real cause – but that they could also be destroyed using revolutionary antiseptic techniques.

“Greenlees was brought in with a compound fracture to his lower leg,” said Dr Hilary Wilson, a consultant rheumatologist who is spearheading efforts to promote the history of Glasgow Royal Infirmary (GRI), the city’s oldest hospital.

“What Lister realised was that if people came in with a break that broke the skin they often died, whereas those who had a break of the bone but not the skin often survived, so he knew there was something in that wound that made patients die.”

Lister anaesthetised the boy with chloroform – itself a cutting edge technology – before washing out the wound, repairing the bone and dressing the injury with carbolic acid. It was the first time Lister had performed antiseptic surgery on a patient, which also included sterilising instruments and wearing protective gloves.

Joseph Lister made his most important breakthroughs in antiseptic surgery while working at Glasgow Royal Infirmary from 1861 until 1869

The boy’s bandages were changed regularly and within six weeks the wound had successfully scabbed over and healed, without infection.

“This wee boy has been reported as being the first case of a compound fracture that left GRI alive,” said Dr Wilson.

“It’s an amazing case, and there’s a picture of Joseph Lister at the boy’s bedside.”

The breakthrough was first reported two years later in a landmark paper in the prestigious medical journal, The Lancet.

Between 1865 and 1869, when Lister left the GRI, his ward’s death rate after surgery dropped to just 15 per cent – a remarkable result for the era.

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This year marks exactly 160 years since the pioneering surgeon first came to work at the GRI following an outpouring of support from the medical students he taught at Glasgow University.

Dr Wilson said: “He had been a surgeon at Edinburgh Royal Infirmary but was promoted to Regius Professor of Surgery at Glasgow University in 1860, but he didn’t have operating rights at the Royal Infirmary.

“Back then you had to be teaching at the university and then you were invited to be a hospital practitioner.

“But medical students found his lectures to be so amazing that they wrote to the hospital appealing that he should be able to have a ward so that he could actually teach his medical students in the hospital, and in 1861 he came to the GRI.”

The pioneering techniques and achievements of Lister are set to be showcased next month, during a week of virtual events hosted online from February 22 and organised by the newly-established Friends of GRI charity.

The initiative is the brainchild of Dr Wilson and colleague Dr Kate Stevens, a consultant nephrologist, who want to celebrate the history of the hospital – which dates back to 1794 – and provide some respite for colleagues after a relentless year of coronavirus.

They also hope to establish a museum in the premises eventually, to exhibit photographs, memorabilia and artefacts from staff past and present, including a table donated by Queen Mary and objects belonging to Lister.

“We’ve been looking to build a sense of camaraderie and good feeling,” said Dr Stevens.

“Because things are not the way we’re used to right now.”

Dr Lindsey Fitzharris, author of The Butchering Art, will be interviewed during Lister Week

Among the highlights of Lister Week will be an interview and Q&A session with Dr Lindsey Fitzharris, an acclaimed medical historian and author of ‘The Butchering Art’ – a deep dive into Victorian surgery which details the work of Lister during his time in Glasgow as well as the stomach-churning practices of the era.

“There was a sort of pride at that time of walking about in your bloodstained overalls because it meant everyone knew you were a surgeon,” said Dr Stevens.

“There was a sense that how dirty your apron was told everyone how busy you were as a surgeon. It’s really quite disgusting to think of it now”

The book also details how Lister and his wife, Agnes, a botanist, would experiment with chloroform at home, trying to work out the optimum amounts needed for safe but effective anaesthesia.

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Dr Stevens said: “His wife had a very keen mind too and they had a common interest, so they would spend time at home experimenting and one of the things they would experiment with was chloroform.

“Nowadays the whole mindset behind medicine and surgery is completely different and we couldn’t contemplate doing surgery without anaesthetic or in a setting that wasn’t sterile, but that was a new thing then so they would spend time working out what was the best way to do this.”

Adored by his students and revered by colleagues, Lister – a Quaker who had considered a religious career before dedicating himself to medicine – was said to be a reserved and shy man.

Dt Kate Stevens with a portrait of Lister at Glasgow Royal Infirmary

Most of all, Dr Wilson says she was pleased to read of his compassion for patients.

“He was actually a very kind person,” she said. “Dr Fitzharris talks about how after his operating session he would come back and help the patient get back into bed, and he would visit them every day to check they were well.

“A wee girl had a toy doll and its leg had fallen off so Lister took it home and sowed the leg back on for her.”

Beyond Lister Week, the medics are eager to highlight some of the less famous heroes of the GRI’s long history, and the world firsts which occurred at the Glasgow site.

It was home, for example, to the world’s first radiology department, set up by medical electrician John Macintyre in March 1896 – just four months after X-rays had been discovered by chance by German physicist Wilhelm Roentgen.

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Roentgen sent details of his findings to Lord Kelvin at Glasgow University, who in turn passed them to Macintyre.

Quickly grasping their significance, Macintyre was granted permission to create an X-ray laboratory for patients at the GRI and would go on to take the first radiological image of a kidney stone in-situ and a foreign body (a halfpenny stuck in the gullet of a child), as well as the first cine-radiogram showing the movement of a frog’s legs.

“They did a demonstration at Glasgow Royal Infirmary of a an X-ray of a frog’s leg moving – but what you could actually see were the bones moving,” said Dr Wilson.

“That was the first use of X-rays in Scotland, showing what it could achieve. From there it’s gone from strength to strength.”

Dr Hilary Wilson, with an edition of the Lancet from 1871

Many GRI women will also be celebrated during have also played a huge part in advancing medicine, including Ellen Brown Orr – the first female surgeon in Scotland – and Rebecca Strong, the hospital’s first matron.

Strong, originally from London, had trained as a nurse after being widowed young and worked alongside Florence Nightingale before coming to Scotland where she served first as matron at Dundee Royal Infirmary before transferring to the GRI in 1879.

She is said to have been shocked at how “backward” the hospital was in relation to nurses’ training, education and working conditions, and set in motion radical reform.

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Her “block apprenticeship” training programme – comprising short periods of instruction in the hospital school and sessions of practical experience on the wards – was later adopted worldwide.

Strong, who died aged 100 in 1944, helped to open a social club for nurses in Glasgow in 1918 and also pushed to improve their working conditions with adequate time for training and holidays.

Schedule of online events for #ListerWeek in February

But she also kept a close eye on her GRI nurses.

“There used to be a thing called the ‘chicken run’ at Glasgow Royal,” said Dr Stevens.

“This was basically a glass tunnel that connected the nurses quarters with the main hospital. You could see into it from matron’s flat – which is still in the hospital – and it was said that matron would be watching to make sure that none of the nurses were bringing men home, or coming in late.

“But it was a very tight unit. They would have things like an annual dance, so we’ve got all these programmes for things like the New Year dance, so it’s been great to find all this stuff.

“If you talk to the FY1s, the junior doctors, about the history of the Royal, they all absolutely love it that they’re working in this big old hospital with so much history.

“There are so many things developed here that have made a difference around the world, so it’s great to be able to share them not just with people in the GRI but in Glasgow and further afield.”

Online events will be open to the public.

For more information visit friendsofgri.org or follow @FriendsofGRI on Twitter.

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