Joseph Lister's unknown operation uncovered By Beth Rose

BBC News Published duration 29 January 2014

image copyright Wellcome library london image caption New research found Joseph Lister (far left) carried out his first operation in the second year of his training

A woman was stabbed in the early hours of Friday 27 June by her drunk husband in the streets of London. The year was 1851 and Jeremiah Sullivan, 59, had invited his wife Julia, a mother of eight, for a drink after she had moved to Camden Town to escape his violence.

She was cautious, inviting a friend along and remaining sober as Sullivan had been overheard making threats against her life.

As they walked along, Sullivan turned on her, lunging forward and stabbing her in the lower abdomen with a knife he had concealed up his sleeve.

image copyright Wellcome LIbrary London image caption Lister overcame smallpox and a breakdown to work as a surgeon

Mrs Sullivan was bleeding heavily and is said to have told a policeman "my entrails are coming out".

She was taken to hospital on Gower Street and handed over to the doctor on duty.

That night that doctor was Joseph Lister, who would later go down in history for pioneering antiseptic surgery.

But at that time he was a second-year medical student at University College London (UCL).

Using new internet databases and by trawling conventional archives, this previously-unknown operation was discovered by medical historian Dr Ruth Richardson who is connected to King's College London (KCL) and Lancaster-based orthopaedic surgeon Bryan Rhodes, who had both been researching Lister's career and had met at a conference at KCL.

"I was working on something else, and I don't know what made me do it but I looked him up on the Old Bailey online and this case came up," said Dr Richardson.

"I mentioned it to Bryan Rhodes and I said to him, 'Is this unusual?', and his eyebrows went right up and he said, 'This is very unusual'.

"The find was a fortuitous guess."

There is much written about Lister, mainly about his work on antiseptic surgery and his use of carbolic acid to sterilise surgical instruments and clean wounds, but less is known about his early career because the records have been lost.

What is known is that Lister enrolled as an arts student at UCL in 1844 at the age of 17, before turning to medicine as a graduate three years later.

After a dangerous attack of smallpox and a nervous breakdown he took time out before returning to medicine in 1849 and took up the position of house surgeon under John Erichsen in 1851.

'Used common sense'

It was previously assumed he had started carrying out surgery much later in his career and none of his biographers seem to have known about this landmark operation.

On that night in June 1851, Lister, faced with Mrs Sullivan's dangerous injury, set about using a mixture of old and new techniques to clean the intestines with blood-warm water, before placing them back into the body.

image copyright Wellcome library London image caption John Erichsen was a surgeon and authority on concussion of the spine

He then put Mrs Sullivan on a strict diet, which included taking opium to make her constipated, in an attempt to give her intestine time to recover.

Dr Richardson said: "Erichsen was the consultant on call, but it would have taken him time to the get to the hospital.

"The woman's bowels were hanging out and he decided to go for it.

"Most patients with such a serious injury would have died, but Lister went at it with a mixture of ways he had read and using his own common sense and it worked."

Two months later Lister found himself at the centre of a trial at the Old Bailey giving evidence alongside Mrs Sullivan.

Sullivan was tried for "feloniously stabbing, cutting, and wounding Julia Sullivan with intent to murder, disable or grievously harm her".

Giving evidence, Lister told the court: "I found a coil of intestine about eight inches across, comprehending, perhaps, about a yard of the small intestines, protruding from the lower part of the abdomen... no doubt all was done by one instrument and one stroke."

He added: "The injury she had received was excessively dangerous - she is now perfectly recovered."

Sullivan was found guilty of causing grievous bodily harm and sentenced to transportation for 20 years.

Lister's quick thinking not only saved his patient from death, but also her attacker from the gallows.

Using the online archives of The Lancet, Mr Rhodes and Dr Richardson found confirmation of Lister's early success with two articles relating to Mrs Sullivan whose recovery was attributable to Lister's "skill and judgement".

Mr Rhodes said: "He's one of my surgical heroes, but it's even more heroic in a way that he came back from his nervous breakdown, smallpox at a time when it was a killer, and then became a star medical student.

"He became a house surgeon earlier than usual - it's like working as a doctor before you've actually qualified. Nowadays that would never happen."

image copyright Wellcome Library London image caption Apparatus used by Joseph Lister in his more familiar field of antiseptic surgery

Both historians consider the discovery of Lister's early operation as "fortuitous", but Lister may also have had some luck on his side.

He probably witnessed hernia cases when he was on the wards that involved returning protrusions of the bowel, and he may also have read up on the subject after The Lancet announced in 1851 the topic for the Fothergillian Gold Medal was Wounds and Injuries of the Abdomen and their Treatment.

GJ Guthrie's lecture on Wounds and Injuries of the Abdomen had also been reprinted in The Lancet only a few weeks before the attack on Mrs Sullivan, but nonetheless it is considered a remarkable achievement for a surgical student.