Joseph Lister

“ Each of Chevalier's compound plano-convex lenses when used singly presented a bur or coma outwards, but when two of them are combined this coma, instead of being exaggerated, as might have been expected, was ‘less than with any single glass,’ while the performance was in other respects satisfactory. ‘Observing the advantages resulting from this combination,’ Lister ‘tried some others,’ among the rest two of Tulley's triple glasses, each of which taken singly was of fine performance. ”

“ On the other hand, separation of the glasses beyond their original interval produces under-correction. Thus, by merely varying the distance between two such lenses, the correction of the spherical error may be either increased or diminished at pleasure according to a definite rule, and slight defects in the glasses can be remedied by simply altering their relative position, the achromatism of the combination being meanwhile little affected.
Lister also explained the relation of the aplanatic foci to the coma. At the shorter focus the coma is inwards, at the longer focus it is outwards ”

“ These truths are even more strikingly exemplified by the fact, which I have elsewhere recorded, [5] that a piece of dead bone, free from decomposition, may not only fail to induce the granulations around it to suppurate, but may actually be absorbed by them; whereas a bit of dead bone soaked with putrid pus infallibly induces suppuration in its vicinity. ”

“ Our fathers would have been greatly astonished to learn that the chlorophyl grains of vegetables were, as has been shown in recent years, living organisms, multiplying by division like the nuclei of their containing cells: and though the pigment granules are much smaller, they must be greatly surpassed in minuteness by many microbes which, though hitherto invisible to us, we believe from analogy to be the causes of some infective diseases. ”

“ Hence it is easy to understand how, when a wound is very large, the crust beneath the rag may prove here and there insufficient to protect the raw surface from the stimulating influence of the carbolic acid in the putty, and the result will be, first, the conversion of the tissues so acted on into granulations, and subsequently the formation of more or less pus. ”

“ In whipped horse's blood the red discs aggregate into dense masses as in blood freshly drawn, and falling rapidly soon leave a deep layer of serum. In whipped cow's blood, rouleaux forming in the serum as in the plasma, there will be found, if the animal was healthy, only a thin superficial serous layer, even after the lapse of 24 hours. ”

“ I found, on dissecting out the vessels from between the layers of the frog's web, and examining them with a high magnifying power, that whereas the capillaries showed only a thin, apparently homogeneous wall beset with occasional nuclei, the finest arteries exhibited three coats, of which the middle one was composed of muscular fibre-cells wrapped spirally round the lining membrane. A more efficient mechanism for their constriction could hardly be conceived. ”

“ There is, however, this enormous difference between the effects of carbolic acid and those of decomposition—viz., that carbolic acid stimulates only the surface to which it is first applied, and every drop of discharge that forms weakens the stimulant by diluting it. But decomposition is a self-propagating and self-aggravating poison ”

“ Now we know, from the experiment with the ox's jugular, that coagulation is propagated with extreme slowness, if at all, from a clot in blood perfectly undisturbed. The earlier coagulation of the main mass of the stirred blood was, therefore, not caused by propagation of the process from a layer upon the surface of the jar, but must have been the result of the brief agency of the glass rod. ”

“ By such facts it seemed to be established that the stasis of the blood in an irritated area, that is to say, the accumulation of the blood-corpuscles, both red and white, in the vessels of that area, is due to a tendency on their part to adhere to each other and to the walls of the vessels; that they do this by virtue of an adhesiveness or viscidity which they do not manifest at all within the vessels of a perfectly healthy part, and which, while varying in degree with the severity of the irritation, never seems to exceed that which is observed in blood outside the body. ”

“ The coagulation of the blood, while it is a matter of fundamental importance in physiology, has peculiar interest for the surgeon, on account of the special feature of coagulability of inflammatory exudations and the part played by lymph in the healing of wounds and various other pathological phenomena, such as the sealing of divided arteries by blood-clot. ”

“ But in some animals, e.g., the horse, the adhesiveness of the discs is so great that they stick to one another by the parts that come first into contact, producing dense spherical masses large enough to be visible to the naked eye, like grains of red sand. These, falling rapidly through the lighter plasma, leave the upper part of the liquid free from red corpuscles before coagulation occurs, thus giving rise to the huffy coat, whereas in the cow the delicate network of rouleaux remains suspended, and no buff occurs. ”

“ Greatly as they differ in their nature, whether physical, as mechanical violence, heat, and the electric shock, or chemical of the most varied characters, one feature they have all in common; if pushed far enough they destroy the tissues on which they act. Extreme inflammatory congestion is the state which they produce when their action is just short of the lethal degree; and it could hardly he doubted that the state of the tissues just short of death must be one of impairment of vital power. ”

“ In spite of hot applications to the skin—which sometimes work like a charm in such circumstances, operating, as it would appear, by distracting, so to speak, the attention of the nervous system from the affected organs—that man died within a few hours of the rigor. ”

“ The tissues, as distinguished from the blood, were therefore the parts primarily and essentially affected by the action of the irritant. And we have seen that, in their relation to the blood-corpuscles, they approached more or less closely, according to the degree of the irritation, the behaviour of ordinary solids, such as glass, as distinguished from the living structures. The natural inference was that they had lost more or less, for the time being, certain special properties which they possessed when in active health as constituent structures of the living body. ”

“ But diffusion was no mere passive phenomenon, such as might follow according to any ordinary arrangement of matter, when the agency that caused the grouping of the molecules ceased to operate. The transference of the granules from the body of each cell to its remotest ramifications, and their close packing there, were an act such as a living organism alone could have effected. Pigmentary concentration and diffusion were vital functions of a profound character concerned with the relative distribution of different constituents of the cells. ”

“ I must content myself with stating the conclusion to which I was led at the time I am speaking of, and which was confirmed by later investigation, viz., that the introduction of septic material into a vein may give rise to the rapid development of large nucleated cells which, growing at the expense of the original constituents of the coagulum, convert it entirely into a thick yellow liquid. ”

“ The pyogenic membrane, like the granulations of a sore, which it resembles in nature, forms pus, not from any inherent disposition to do so, but only because it is subjected to some preternatural stimulation. In an ordinary abscess, whether acute or chronic, before it is opened, the stimulus which maintains the suppuration is derived from the presence of the pus pent up within the cavity. When a free opening is made in the ordinary way, this stimulus is got rid of ”

“ In a narrow ring round the mustard, where the volatile oil could only act extremely mildly on the web, the stellate condition gave place to complete diffusion; whereas under the mass, where the irritant had acted at once with full energy, the stellate appearance remained unchanged. Inflammatory congestion, however, had been produced in the ring of full diffusion as well as in the more strongly irritated area. It happened that complete concentration afterwards took place in the rest of the web, while the irritated areas retained the appearances above described. ”

“ It is matter for discussion how inflammatory congestion is brought about by nervous action. It may be doubted whether active congestion could alone give rise to it, though it is by no means inconceivable that the excessive supply of the nutrient fluid might in time exhaust the tissues by over-stimulation, and so bring about more or less of that impairment of vital energy which we have seen reason to regard as the essential cause of the blood-corpuscles lagging behind the liquor sanguinis. ”

“ A very interesting observation which I made long ago, but to which I have not before directed attention in this point of view, shows that an extreme degree of adhesiveness of the red discs may exist within a blood-vessel the walls of which are in perfect health with reference to coagulation. If a horse's jugular vein, obtained in the manner I have described, is suspended vertically, the blood in it remains fluid for an indefinite period, hut the red corpuscles soon fall from the upper parts of the fluid, leaving a huffy layer of plasma, readily seen through the translucent wall of the vessel. ”

“ For adhesiveness of corpuscles is not occasioned in the frog's web by amputation of the limb; nor is it produced in the human subject by complete detachment of a portion of tissue; as is clearly shown by the persistent healthiness of a piece of skin entirely transplanted in skin-grafting. We are therefore forced to the conclusion that the adhesiveness of the red discs in the horse's jugular, as contrasted with its complete absence in the vein of the bat's wing, was due to the larger size of the vessel in the former case. ”

“ Yet from the very happy circumstance of the conspicuousness of the pigment, the results of their activity could be observed with the utmost facility, and their behaviour in relation to inflammatory congestion easily studied even under a low magnifying power.
The pigment cells pervade the skin and subcutaneous tissue of which the frog's web consists, and are especially numerous about the blood-vessels, round which their branches twine abundantly. They must, therefore, be acted on along with the vascular parietes by anything applied to the surface of the membrane. ”

“ In order that the treatment may be satisfactory, the abscess must be seen before it has opened. Then, except in very rare and peculiar cases, [6] there are no septic organisms in the contents, so that it is needless to introduce carbolic acid into the interior. Indeed, such a proceeding would be objectionable, as it would stimulate the pyogenic membrane to unnecessary suppuration. All that is necessary is to guard against the introduction of living atmospheric germs from without, at the same time that free opportunity is afforded for the escape of discharge from within. ”

“ His eyes got brighter and his complexion clearer, nor was he as pleased as one of the other sex might have been when the self-satisfied Henshaw pointed out these improvements to his companions, and claimed entire responsibility for them. It is probable that Mr. Lister, under these circumstances, might in time have lived down his taste for strong drink, but that at just that time they shipped a new cook.
He was a big, cadaverous young fellow, who looked too closely after his own interests to be much of a favourite with the other men forward. ”

“ For I afterwards learned that the normal temperature of man is deadly to the cold-blooded frog. That animal, which under ordinary conditions exhibits very remarkable persistence of vitality even after somatic death, is killed by being held for about a quarter of an hour in the hand; and if one of its hind feet be similarly warmed, the blood-corpuscles will be found packed and stagnant in the vessels of the webs, as if mustard or any other powerful irritant had been applied to them. ”

“ At the same time any constitutional symptoms previously occasioned by the accumulation of the matter are got rid of without the slightest risk of the irritative fever or hectic hitherto so justly dreaded in dealing with large abscesses. ”

“ The cook gasped, and with gentle firmness took the cabbage from him as being unfit work for a man of such wealth.
"It's very nice," he said, slowly. "It's very nice. You'll be able to live on it in your old age."
Mr. Lister shook his head mournfully, and his eyes became humid.
"There's no old age for me," he said, sadly; "but you needn't tell them," and he jerked his thumb towards the forecastle.
"No, no," said the cook.
"I've never been one to talk over my affairs," said Mr. Lister, in a low voice. "I've never yet took fancy enough to anybody so to do. ”

“ At fourteen years of age he left school to assist his father in the wine trade; but though for many years closely occupied in business, he contrived by early rising and otherwise to largely supplement the education he had received at school, and was as regards his mathematical knowledge a self-taught man. ”

“ Under intense irritation the capillary walls will naturally be affected by the noxious agency as the veins of the sheep's foot were by the constricting cord, and, like them, will act upon their contained blood as if they were ordinary solids. The plasma of that blood will therefore receive from the blood-corpuscles the material requisite for forming fibrin, and, passing through the pores of the capillaries with that addition, will constitute a coagulable exudation. ”